Employment Application

You must complete both sections for your application to be considered

Please complete BOTH forms below

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Position Applied For

Date of Application

YYYY

Date Available to Start

YYYY

Desired Salary

Are you a citizen of the United States?

If no, are you authorized to work in the U.S.?

Have you ever worked for Long Island Science Center?

If yes, when?

Have you ever been convicted of a felony?

If yes, explain (note, we require background checks for all employees with direct contact with students):

EDUCATION INFORMATION

High School Attended

High School Address

Date Attended From - To

Did you graduate?

Diploma

College Attended

College Address

Date Attended From - To

Did you graduate?

Degree

Other Education

Other Education Address

Did you graduate?

Degree

REFERENCES - Please list three professional references

Name of Reference 1

First Name

Last Name

Relationship

Company Name

Address

Phone

(###)

###

####

Name of Reference 2

First Name

Last Name

Relationship

Company Name

Address

Phone

(###)

###

####

Name of Reference 3

First Name

Last Name

Relationship

Company Name

Address

Phone

(###)

###

####

If you are applying for an educator position, are you fingerprinted through the New York State system?

You must complete the previous employment form below as well for your application to be considered complete

Previous Employment Information

You must complete this section as well and submit it for your application to be considered.

Name

First Name

Last Name

Company Name 1

Address

Website

http://

Supervisor's Name

First Name

Last Name

Phone

(###)

###

####

Job Title

Responsibilities

Dates Employed From - To

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer?

Company Name 2

Address

Website

http://

Supervisor's Name

First Name

Last Name

Phone

(###)

###

####

Job Title

Responsibilities

Dates Employed From - To

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer?

Company Name 3

Address

Website

http://

Supervisor's Name

First Name

Last Name

Phone

(###)

###

####

Job Title

Responsibilities

Dates Employed From - To

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer

MILITARY SERVICE

Branch

Dates of Service From - To

Rank at Discharge

Type of Discharge

DISCLAIMER & SIGNATURE:

Verification of Information

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I also understand that employment requires a completed background check.

Date

YYYY

Type your name below to certify the information you have provided in the employment and previous employment forms.