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  We  are  glad  to  hear  that  you  are  interested  in  joining  the  SJW  counselor  team!    

  Please  complete  and  return  this  application  to:    

 

  P.O.  Box  20454,  Stanford,  CA  94309  

  Direct:  650-­‐736-­‐0324  X  303  Fax:  650-­‐856-­‐4155    

  SJW  is  an  Equal  Opportunity  Employer  

  Please  complete  the  application  on  computer  or  print  to  complete  it  by  hand.    

  Be  sure  to  sign  the  application  before  you  send  it.    

   

DATE:  ______________  

________________________          ____________________        _________________  M          F             Last  Name     First  Name                                                          Middle  

Present  Address:  

__________________________________      ___________________      ________      _____________  

No.  &  Street   City   State   Zip  

Permanent  Address  (if  different  from  present  address):  

__________________________________      ___________________      ________      _____________  

No.  &  Street   City   State   Zip  

 ______________      ____________      _______________________      __________        ___________  

Weeks  Available  to  Work:  

Jazz  Camp,  Week  1:     Yes              No                 Jazz  Camp,  Week  2:     Yes              No                 Jazz  Institute:       Yes              No                

Personal  Information  

Have  you  ever  attended  SJW  camps,  or  worked  for  SJW  before?  Yes              No                 If  yes,  please  describe  your  experience:    

         

     Counselor  Applica//on  

See page 5, bottom, for instructions on saving your completed application in Adobe Reader.

July  18-­‐July  25   July  25-­‐August  1 August  1-­‐8

Janel  Thysen,  Director  of  Program  Opera88ons    (janel@stanfordjazz.org)  

Cell  Phone                                Home  Phone            Email  address              Date  of  Birth      Age  on  7/1/15   Jazz  Day  Camp: July  13-­‐July  17 Yes              No                

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Do  you  have  friends  or  relatives  who  work  for  SJW?  Yes              No                 If  yes,  state  name(s)  and  relationship:  

Name  _______________________________________    Relationship    _____________     Name  _______________________________________  Relationship    _______________     If  hired,  will  you  have  a  car  available  at  on  campus?  Yes              No                

If  offered  employment  you  must  be  able  to  provide  two  pieces  of  identification  as  evidence  of   your  U.S.  citizenship  or  proof  of  your  legal  right  to  live  and  work  in  the  United  States.  

Do  you  have  two  of  the  following  documents  available  now?  Yes              No                 If  yes,  which  documents  can  you  provide?  (e.g.,  valid  Driver’s  License  issued  by  US   state;  US  Passport;  US  certificate  of  birth):  

     

You  must  be  able  to  perform  the  essential  functions  of  the  job  for  which  you  are  applying,  either   with  or  without  reasonable  accommodation.  Do  you  have  this  ability?    Yes            No            

Have  you  ever  been  convicted  of  a  criminal  offense  (felony  or  serious  misdemeanor)?       Yes          No    

   

Education,  Training,  and  Experience  

High  School  You  Attended:  _______________________  City  _______________  State  _____  

College/University  Attended:  ________________________________________   State  ______     Years  Completed  _____  Degree(s)  Earned  ______________  Year  Degree  Awarded:  ______   College/University  Attended:  ________________________________________   State  ______     Years  Completed  _____  Degree(s)  Earned  ______________  Year  Degree  Awarded:  ______   College/University  Attended:  ________________________________________   State  ______     Years  Completed  _____  Degree(s)  Earned  ______________  Year  Degree  Awarded:  ______    

Years  Completed:  ___  Did  you  Graduate?  Yes            No                    Degree  or  Diploma?  ___________   Yes          No    

 If  yes,  state  nature  of  the  crime(s),  the  date  and  loca66on  of  your  convic66on,  and  disposi66on  or  

current  status  of  the  case:    

(Note:  No  applicant  will  be  denied  employment  solely  on  the  grounds  of  convic::on  of  a  criminal  offffense.   The  nature  of  the  offffense,  the  date  of  the  offffense,  the  surrounding  circumstances  and  the  relevance  of   the  offffense  to  the  posi::on(s)  applied  for  may,  however,  be  considered.)  

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Describe  your  music  education  and  background:  instruments  played,  education  (apart  from  SJW   camps),  etc.    

         

Describe  your  experience  working  with  kids  or  teens  in  a  leadership  role.  Please  list  the  ages  of   kids/teens  you  have  experience  working  with.      

     

Employment  History  

List  below  all  present  and  past  employment  in  which  you  worked  with  children.  List  your  most   recent  employer  (include  only  the  past  five  years).  

Name  of  Employer/Business  ___________________________________    Phone:  _______________    

Nature  of  Business  _________________________  Supervisor:  _______________________________   Street  Address:  _________________________City  _________________  State  ___  Zip  _____   Dates  of  Employment:  ___________  to    ____________  Rate  of  Pay  (Hr/Wk):    _______________   Your  Position  and  Duties:    

   

Reason  for  Leaving:      

 

May  we  contact  this  employer  for  a  reference?  Yes          No      

Name  of  Employer/Business  ___________________________________  Phone:  _______________  

Nature  of  Business  _________________________  Supervisor:  ______________________________   Street  Address:  ___________________  City  _________________  State  ___  Zip  _________   Dates  of  Employment:  ___________  to    ____________  Rate  of  Pay  (Hr/Wk):    _______________   Your  Position  and  Duties:    

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May  we  contact  this  employer  for  a  reference?  Yes            No            

Name  of  Employer/Business  ___________________________________  Phone:  _______________  

Nature  of  Business  ________________________    Supervisor:  _______________________________   Street  Address:  ___________________  City  _________________  State  ____  Zip  __________   Dates  of  Employment:  ___________  to    ____________  Rate  of  Pay  (Hr/Wk):    _________________   Your  Position  and  Duties:    

 

Reason  for  Leaving:      

May  we  contact  this  employer  for  a  reference?  Yes            No            

Name  of  Employer/Business  ___________________________________  Phone:  _______________  

Nature  of  Business  ________________________    Supervisor:  _______________________________   Street  Address:  ___________________  City  _________________  State  ____  Zip  __________   Dates  of  Employment:  ___________  to    ____________  Rate  of  Pay  (Hr/Wk):    _________________   Your  Position  and  Duties:    

 

Reason  for  Leaving:      

References  

Please  provide  contact  information  for  three  references  who  are  not  related  to  you  who  have   knowledge  of  your  work  performance  in  the  last  three  years,  particularly  with  individuals  ages   11  to  17.  

First  Name  __________________   Last  Name  __________________  Phone:  _______________   Email:  ______________________  

Street  Address  ___________________________  City  _____________  State  ___  Zip  ______   Relationship  to  you:  ______________________  No.  of  Years  Acquainted  __________  

First  Name  __________________   Last  Name  __________________  Phone:  _______________   Email:  ______________________  

Street  Address  ___________________________  City  _____________  State  ___  Zip  ______   Relationship  to  you:  ______________________  No.  of  Years  Acquainted  __________  

First  Name  __________________   Last  Name  __________________  Phone:  _______________   Email:  ______________________  

Street  Address  ___________________________  City  _____________  State  ___  Zip  ______   Relationship  to  you:  ______________________  No.  of  Years  Acquainted  __________  

 

May  we  contact  this  employer  for  a  reference?  Yes  

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Please  Read  Carefully,  Initial  Each  Paragraph  and  Sign  Below  

affect  my  chances  for  employment  and  that  the  answers  given  by  me  are  true  and  correct  to  the   best  of  my  knowledge.  I  further  certify  that  I,  the  undersigned  applicant,  have  personally  

completed  this  application.  I  understand  that  any  omission  or  misstatement  of  material  fact  on   this  application  or  on  any  document  used  to  secure  employment  shall  be  grounds  for  rejection   of  this  application  or  for  immediate  discharge  if  I  am  employed,  regardless  of  the  time  elapsed   before  discovery.  

______  I  hereby  authorize  SJW  to  investigate  my  references,  work  record,  education  and  other   matters  related  to  my  suitability  for  employment  and,  further,  authorize  the  references  I  have   listed  to  disclose  to  SJW  any  and  all  letters,  reports  and  other  information  related  to  my  work   records,  without  giving  me  prior  notice  of  such  disclosure.  In  addition,  I  hereby  release  SJW,  my   former  employers  and  all  other  persons,  corporations,  partnerships  and  associations  from  any   and  all  claims,  demands  or  liabilities  arising  out  of  or  in  any  way  related  to  such  investigation  or   disclosure.  

______  I  understand  that  nothing  contained  in  the  application,  or  conveyed  during  any   interview  that  may  be  granted  or  during  my  employment,  if  hired,  is  intended  to  create  an   employment  contract  between  Stanford  Jazz  Workshop  and  me.  In  addition,  I  understand  and   agree  that  if  I  am  employed,  my  employment  is  for  no  definite  or  determinable  period  and  may   be  terminated  at  any  time,  with  or  without  prior  notice,  at  the  option  of  either  myself  or  SJW,   and  that  no  promises  or  representations  contrary  to  the  foregoing  are  binding  on  SJW  unless   made  in  writing  and  signed  by  me  and  SJW’s  designated  representative.  

Applicant’s  Signature    ___________________________________  Date:  _________________     _____  I  hereby  cer**fy  that  I  have  not  knowingly  withheld  any  informa**on  that  might  adversely  

1. Click the "Sign" icon in the top, right hand corner of the Adobe Reader window. 2. Select either "Add Text" or "Place Signature" to sign the document.

3. Click "Signed, proceed to send."

4. Save by clicking the "Save a Copy" (floppy disc icon).

Instructions for saving your completed application in Adobe Reader:

References

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