1. Full Name___________________________________________________________
2. Full Address _________________________________________________________  
3. Telephone ______________________   Cell Phone __________________________
4. Email Address ______________________________________________
5. Date of Birth ______________      Social Security Number ________________________
6. Education Information (date graduated or expected graduation):

Undergraduate ____________     Graduate ______________    Trade ____________
Name of College/University _____________________________________________________
Concentration _______________________________________________________________
Degree received or working on _________________________________________________
7. Additional Training/Education___________________________________________________
__________________________________________________________________     
8. Additional Experience you have received ________________________________________________
___________________________________________________________________________
9. What are your availability hours (day and night) _________________________________________
10. What are your career goals ____________________________________________________________
11. Why do you want a position at Sunshine? ________________________________________________
12. Position Desired ____________________________  Salary Expected ______________________
13. Are you applying for:     Volunteer ______    Internship ______    Paid _______    Other _______
14. Present Employer ____________________________________________________________________
How long have you worked here? _____________________    Phone __________________________
Contact ________________________________   Job position ________________________________
15. Past employers and information that may be helpful to our decision _________________________
_______________________________________________________________________________________

References that will be helpful in making our decisions (Please include school professors and advisors and other professional people who have worked with you and know your abilities)
Name ______________________________________   Phone ____________________________________
How do you know this person _____________________________________________________________
Name ______________________________________   Phone ____________________________________
How do you know this person _____________________________________________________________
Name ______________________________________   Phone ____________________________________
How do you know this person _____________________________________________________________
Name ______________________________________   Phone ____________________________________
How do you know this person _____________________________________________________________
17. Have you ever been convicted of a crime? _____________  Give Details on back
18. Have you ever been entered in a registry as a result of any child abuse or neglect? ___________  
 
 
 
 
 By signing my signature on this application, I
a. Understand the philosophy of the center has at its core belief that all staff (paid and nonpaid) should refrain from alcohol and drug abuse
b. Understand that all adult staff working with children/teens must model the no-use or responsible drinker message
c. Understand there is a zero tolerance for underage drinking and alcohol/drug use and misuse
d. Authorize the verification of above information
e. I hereby agree to sign all waivers and background checks
f. Affirm that all the above information is true.  Any false statement will be a cause for termination.
 

Applicants Signature ______________________________________   Date _____________
 

 
I hereby authorize the Suffolk County Police Department to perform a complete record check on myself, including sealed records, and they may release it directly to Sunshine Center/Sunshine Prevention Center for Youth and Families.
(Please print clearly and readable or the background check process will be delayed)
 
Name _________________________________________________  

Signature ______________________________________________Date: _________

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