Help for Troubled Teens and Adolescents at Risk at the Discovery Schools of Virginia

P.O. Box 1160 Dillwyn, VA 23936 Phone: 434-983-5616 Fax: 434-983-5617 admissions@discoveryschool.org

Your interest in our organization is appreciated. We comply with state and federal laws regarding equal opportunity. Qualified applicants are considered for all positions without regard to race, color, religion, sex, age, disability, national origin, veteran status, or citizenship status.

Applications are kept on file for 6 months. If you have not been hired within 6 months of the date of your application, you must re-file if you are to be considered for future employment.

Position Desired:	


Name:		
SSN:		
E-mail:		
Phone:		

Address:		
City:		
State:		
Zip Code:	
Country:		

Have you ever been known by any other name?	 Yes	 No
If Yes, what is the name?	

Have you ever been convicted of a felony?	 Yes	 No
If Yes, describe in full:	

Are you a citizen of the United States?	 Yes	 No
If No, give Alien Registration Number:	

Are you over 18?			 Yes	 No
If No, do you have a work permit?	 Yes	 No

Do any of your friends or relatives work here?	 Yes	 No
If Yes, list name(s):	

List any skills, qualifications, courses, or training you have
that relates to the position for which you are applying:

High School:		
Years Completed:		
Did you graduate?	 Yes	 No
Diploma or Degree:	

College/Technical:	
Years Completed:		
Did you graduate?	 Yes	 No
Diploma or Degree:

Company #1:	
Employed From:		To: 
Position Held:	
Responsibilities:	

Company #2:	
Employed From:		To: 
Position Held:	
Responsibilities:

Name:		
Address:		
Phone:		

Name:		
Address:		
Phone:		

Name:		
Address:		
Phone: