Home Programs & Curriculum About Us Staff Events Contact  

This application must be filled out in it's entirety for us to review it. If an item does not apply to you simply state "N/A" (not applicable). If you would like to print this application and fax or mail it in please click here to download a pdf version of our application form and fax it to:
603-382-0030 or mail it to:

Plaistow Learning Center, Inc.
95 Plaistow Road
Plaistow, NH 03865


* Denotes a required field.
Personal Information


*First Name:

Middle Initial: *Last Name:

Present Address (NO P.O. Boxes)
*Street No. & Name: Apt# (if any): *City:
* Postal Code: Email Address

*Home Phone w/area code: *Mobile Phone: Pager:
*Are you 18 years or older?
*Are you either a U.S. Citizen or Alien authorized to work in the U.S.?
*In case of emergency notify: Relationship to Applicant:
*Address: *City: *Phone:



Desired Employment

Position Date you can start? Salary Desired?
Are you currently employed? If yes, may we contact your current employer?
Have you ever applied to this company before? If yes, when?
Have you ever worked for this company before?
How were you referred to this company?

 


Please List your last (3) Three Employers


Name of Present or Last Employer:
Address: City: State: Zip Code:
Starting Date: Ending Date: Job Title:
Starting Salary: Ending Salary: May we contact your supervisor?
Name of Supervisor: Supervisor Contact Number: Description of work:
Reason for leaving:


Name of Employer:
Address: City: State: Zip Code:
Starting Date: Ending Date: Job Title:
Starting Salary: Ending Salary: May we contact your supervisor?
Name of Supervisor: Supervisor Contact Number: Description of work:
Reason for leaving:


Name of Employer:
Address: City: State: Zip Code:
Starting Date: Ending Date: Job Title:
Starting Salary: Ending Salary: May we contact your supervisor?
Name of Supervisor: Supervisor Contact Number: Description of work:
Reason for leaving:


 

 

 

Home Contact Us Programs & Curriculum Events Staff Privacy Policy About Us