Employment Application
Bilingual Program Specialist - Lake County, Indiana
EEO Statement: It is the policy of IN*SOURCE to provide equal employment opportunity (EEO) to all persons regardless of race, creed, color, religion, sex, national origin, veteran status, ancestry, age, genetic information, physical or mental disability, or any other characteristic protected by law. In addition, IN*SOURCE will provide reasonable accommodations for qualified individuals with disabilities.
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Application Date
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Name
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Present Address
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City State Zip
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Home Phone Number
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Work Phone Number
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Cell Phone Number
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Email Address
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Referred by
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Job(s) Applied for
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Date Available
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List persons you know who work at IN*SOURCE
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Is there any reason you might not be able to perform duties?
If "Yes," describe and explain your work limitations
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High School Name
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High School # Years Attended
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Graduated High School
High School Course of Study
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College Name
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College # Years Attended
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Graduated College
College Course of Study
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Graduate School Name
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Graduate School # Years Attended
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Graduated Graduate School
Have you served in the Armed Forces?
Branch of Service
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What were your duties (include special training)
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Employer 1
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Employer 1 Address
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Date of Employment 1 From
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Date of Employment 1 To
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Employer 1 - Describe the work you do or did
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Employer 1 Supervisor
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Employer 1 Telephone
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Employer 1 Reason for Leaving
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Employer 2
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Employer 2 Address
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Date of Employment 2 From
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Date of Employment 2 To
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Employer 2 Describe the work you do or did
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Employer 2 Supervisor
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Employer 2 Telephone
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Employer 2 Reason for Leaving
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Personal References
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Additional Information
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Why are you interested in this position?
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What skills and strengths do you have that will help you successfully work with parents in your area?
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Describe how you have responded as an advocate in a situation in which feelings were tense.
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Applicant's Authorization for Reference Checks
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