Telluride Academy Staff Site - Registration

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Registration
Name:
Username:
E-mail:
Password:
Verify Password:
Staff Information:
Public Email Address:
Date of Birth:
Social Security Number:
Drivers License # (incl. state):
Cell Phone:
Alternate Phone:
Current Address:
City:
State:
Zip Code:
Alternate Address:
Public Profile:
Hometown:
What I was doing before:
Are you a new or returning staff member:
About Me:
Background Check Information (will not be public information)
The following information will be used to perform a national background check, the results of which are a condition of your employment with Telluride Academy. Please provide us with your past two addresses or the last 7 years of your residential history including county and zip.
I authorize a background check:
Previous Address #1:
Addr #1 Dates:
Previous Address #2:
Addr #2 Dates:
Previous Address #3:
Addr #3 Dates:
Rate Your Experiences: 1=None 5=Expert
Climbing:	1 2 3 4 5
Mountaineering:	1 2 3 4 5
Mountain Biking:	1 2 3 4 5
Hiking:	1 2 3 4 5
Backpacking:	1 2 3 4 5
Outdoor education/science curriculum:	1 2 3 4 5
Theatre and Dance:	1 2 3 4 5
Horses:	1 2 3 4 5
Swim/lifeguarding:	1 2 3 4 5
Art Projects:	1 2 3 4 5
Knowledge of Southwest Colorado:	1 2 3 4 5
Kayaking:	1 2 3 4 5
Canoeing:	1 2 3 4 5
Driving 15-passenger vans:	1 2 3 4 5
Additional Special Interests to Share:
Certifications & Licenses NOTE: You will need to provide a copy of your certifications to us.
CPR:	Yes No
CPR Expiration:
First Aid:	Yes No
First Aid Expiration:
WFA:	Yes No
WFA Expiration:
WFR:	Yes No
WFR Expiration:
Swift Water:	Yes No
Swift Water Expiration:
Attending Telluride Academy Wilderness First Aid Training or CPR? (June 3-4):	Yes No

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