Employment Application

Last Name (Family Name): First Name (Given Name): Middle: Date: App Checked: ______

Newell William DREW 11/22/24 Date Hired: ______

AIM / I9: ______
Street Address: City: State: Zip: Are you 18 years
E-Verified: ______
of age or older?
1183 Diamond Dr # E Los Alamos, NM 87544 Entered JKM: ______
■ Yes No
Primary Phone: Email: Type of Assignment Desired:
(505) 609-7905 bfspade@gmail.com ____Full Day ____ Half Day ____■
Any Available
Length of Assignment Preferred: Do you have a valid AZ IVP Fingerprint Card? Do you have a valid AZ Teaching or Substitute Certificate?
■ ■
____Same Day ____Long Term ____Any Available _____ Yes ______ No _____ Yes
■
______ No

EDUCATIONAL B ACKGROUND
Number of Yrs
Name of School City, State Attended Outcome Course of Study
College: Degree? Sociology
Charlotte, NC 4 ___Yes
■
___No
UNC-Charlotte
Graduate School: Degree?
___Yes ___No
Other School/Certification: Degree or Certificate?
Social Studies
Santa Fe, NM ___Yes
■
___No
NM Teaching License

EMPLOYMENT EXPERIENCE
Start with your current or last job. You may exclude organizations that indicate race, color, religion, gender, national origin, disability or other protected status.
Employer Name & Address: Job Title:
(1) Santa Fe Public Schools Substitute Teacher

Dates Employed (most recent): Supervisor’s Name & Title: Supervisor’s Phone Number: Supervisor’s Email Address:
From:09/15/24 To: current Robert Baker / ESS | Regional Manager (New
336.466.6663
Mexico) rbaker@ess.com

Work Performed: Reason for Leaving: May we contact this Employer? _____
■
Yes _____No
Substitute Teacher - Pre K to 12th grade If No, please explain:

Employer Name & Address: Job Title:

(2) UBER / 1455 Market St, San Francisco, CA 94103 Driver - Taxi & Delivery

Dates Employed (most recent): Supervisor’s Name & Title: Supervisor’s Phone Number: Supervisor’s Email Address:
From:08/01/2017 To: current NA NA NA

Work Performed: Reason for Leaving: May we contact this Employer? _____
■
Yes _____No
Deliver Packages and Taxi people to destination If No, please explain:
Not sure how you would contact anyone

Employer Name & Address: Job Title:

(3) Laveen Elementary School District No. 59 / 5001 W. Dobbins Road Laveen, Arizona 85339-9733
Substitute Teacher

Dates Employed (most recent): Supervisor’s Name & Title: Supervisor’s Phone Number: Supervisor’s Email Address:
From:03/15/2024 To: Holly King / Human Resources 602-237-9100 ext. 3014
Technician-Certified Staff hking@laveeneld.org
Work Performed: Reason for Leaving: May we contact this Employer? _____
■
Yes _____No
Substitute Teacher - Pre K to 5th grade If No, please explain:

Employer Name & Address: Job Title:

(4) Carlos Vigil Middle School / 1260 Industrial Park Rd, Espanola, NM 87532 Teacher - Social Studies

Dates Employed (most recent): Supervisor’s Name & Title: Supervisor’s Phone Number: Supervisor’s Email Address:
From:07/15/2022 To:01/ 15 /2023 Yvette Bakken / Principle 505-753-1348 yvette.bakken@k12espanola.org

Work Performed: Reason for Leaving: May we contact this Employer? _____ ■
Yes _____No
Social Studies teacher for 7th and 8th Grade - Geography,
Additional
History,schooling
Etc If No,
was required for me to stay please as
employed explain:
a teacher - out of my own pocket. I did fulfill the term

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PROFESSIONAL REFERENCES
Name: Relationship/How Acquainted Years Known: Phone: Email:
Yvette Bakken Principle at CVMS 2.5 505-901-2047 yvette.bakken@k12espanola.org

Name: Relationship/How Acquainted Years Known: Phone: Email:

Peter Byrne Former Manager / Newell Consulting
10 919-407-2117 petermason.byrne@gmail.com

Name: Relationship/How Acquainted Years Known: Phone: Email:

Harold Berdiansky Friend / Client Website Design 20 984-298-5948 baltimoremybaltimore@gmail.com

Have you worked for this Do any of your friends or relatives currently work If yes, name of relative or friend:
company before? for this company?
This person is a:
■ ■
_____ Yes _____ No _____ Yes _____ No
______ Temporary Employee _____ Staff Employee

Applicant’s Certification Statement: I certify that the information given herein is true and complete to the best of my knowledge.

I understand that any falsification, misrepresentation, misleading or material omission of information on my application, resume or
interview(s) (regardless of when discovered) may result in a failure to receive an offer of employment or, if already hired, termination of my
employment at any time.

I authorize the employer to contact all references specified in this application. I authorize those references to provide the employer any and
all information concerning my previous employment and I release all parties, companies and persons providing such information to the
employer from any liability for any damages that may result from furnishing such information to the employer as well as from the use or
disclosure of such information by the employer or any of their agents, employees, or representatives.

11/22/24
Signature: ______________________________________________ Date: _____________

Email to Phoenix/Tempe Office

Email to Tucson Office

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