Special Recreation Services
Employment Application
Email address *
First and Last Name *
Address (include City, State and Zip) *
County (Example: Monroe, Carbon, etc) *
Township/Borough in which you pay taxes. (For example if your address says Stroudsburg but you might actually live in Stroud Township). *
Phone *
Are you a United States Citizen? *
Are you legally eligible to work in the USA? *
Are you a US Veteran? *
If selected for employment are you willing to submit to a background check and a drug test? *
Please list any languages you speak besides English. Please include if you are trained in Sign Language. *
Position you are applying for? *
Available Start Date *
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Desired hourly pay? *
Employment Desired *
High School Name and Address including city and state *
Did you graduate? *
College Name and Address. (Put N/A if not applicable) *
Did you receive a degree *
Any other school (trade/technical) attended? *
List any certifications and specialized training you may have. (include CPR) *
List your most recent employer Name and Address. (If no recent employment please list any recent volunteer experience) *
Dates employed/volunteered there and your position. Please list start date and end date. (example: Sept 2019 to May 2020) (or if you are still there put Sept 2019 to Present) *
Supervisor's name and phone # *
Briefly list your job responsibilities. *
Past Employer #2 Name and Address *
Dates employed/volunteered there and your position. Please list start date and end date. (example: Sept 2019 to May 2020) (or if you are still there put Sept 2019 to Present) *
Supervisor's Name and Phone # *
Briefly list your job responsibilities *
References (please DO NOT list family members. Only list professional/business/friend/co-worker): Name and Phone # of Reference #1 *
Occupation of Reference #1 *
How long have you known reference #1? *
References (please DO NOT list family members. Only list professional/business/friend/co-worker): Name and Phone # of Reference #2 *
Occupation of Reference #2 *
How long have you known Reference #2 *
Please read and electronically sign below: The information I have provided above is correct and truthful to the best of my knowledge. I understand that any false statements provided by me to Special Recreation Services in this application or interview could result in non-hiring or termination of my position. I also understand that filling out this application does not guarantee a position with Special Recreation Services. *
A copy of your responses will be emailed to the address you provided.
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