SJNC Application

Application Form

References

Please list three personal, professional, academic, or spiritual leader references.

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship: Company: Phone: Address:

Full Name: Relationship:

Company: Phone:

Responsibilities:

Responsibilities:

From: To:

May we contact your previous supervisor for a reference?

Branch:

Rank at Discharge:

If other than honorable, explain:

Reason for Leaving:

YES NO

Military Service

From: To:

Type of Discharge:

Personal Financial Status

Current Monthly Income (including assistance from parents, friends or other source)

From work, before taxes:

How would you rate your credit:

1 (Excellent), 2 (Very Good), 3 (Good), 4 (Poor)

From parents, child support, or other sources:

TANF Cash Assistance from Government:

Lifestyle Status

Marital Status:

With Whom Do You and Your Children Live: (Parents, Friends, Boyfriend, Relatives, Other)

Career Plans

What are your career goals?

Past Accomplishments

Please tell us about your past accomplishments: awards, participation in clubs, youth organizations, volunteer experiences.

Essay

Why do you believe you would be a candidate for this program?”. We recommend you write your answer in a separate document and submit with your application (answer can include: financial, health, career, family, and/or life hopes and dreams)

Disclaimer and Signature

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.

Signature:

Date: