DASAC Counselor Applicants for employment are considered without regard to race, color, religion, sex, sexual orientation, transgender status, marital status, national origin, ancestry, genetic information, age, disability, status as a veteran or being a member of the Reserves or National Guard, or any other category protected under state or federal law. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. Name:* First Last Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Email: Enter Email Confirm Email Please indicate how you learned about this position:*Deerfield Academy Website (www.deerfield.edu)Publication or WebsiteDeerfield EmployeeAttended a job fairApplying without knowledge of specific positionOtherPublication or Website Name:Employee Name:Job Fair Name:Other (please explain):Are you under 18?*YesNoCan you furnish a work permit?Have you filed an employment application at Deerfield Academy in the past?*YesNoIf yes, for which position?Have you ever been employed by Deerfield Academy?*YesNoIf yes, please provide dates:Are you employed now?*YesNoIf yes, please list employer name:Are you eligible to work in the U.S.?*YesNo ***Proof of identity and eligibility will be required upon employment.Educational HistoryHigh School:Years Completed:Degree/Course of StudyCollege/University:Years Completed:Degree/Course of StudyGraduate SchoolYears CompletedDegree/Course of StudyBusiness/Technical SchoolYears CompletedDegree/Course of StudyEmployment ExperiencePlease list previous employment that is relevant to the position you are applying for at Deerfield Academy. Employer:*Job title:*Dates of employment:*Reason for Leaving*Employer:Job title:Dates of employment:Reason for LeavingEmployer:Job title:Dates of employment:Reason for LeavingReferencesPlease provide three professional references.Reference #1 Company or Institution NameName First Last TitleEmailTelephone NumberReference #2 Company or Institution NameName First Last TitleEmailTelephone NumberReference #3 Company or Institution NameName First Last TitleEmailTelephone NumberSupporting DocumentsPlease attach the following documents to be included with your application. PDF format is preferred to preserve document formatting. Other acceptable formats are Microsoft Word (.doc, .docx) and text (.txt).Attach Resume:*Attach Cover Letter:*Additional Document:Additional Document:Additional Document:AgreementBy signing below, I certify that I understand that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by Deerfield Academy. I understand an agree that if hired, my employment is at-will and I may terminate it at any time for any reason, with or without notice, with or without cause, and Deerfield Academy may do the same, I also understand that this statement supersedes any and all oral representations made by agents or representatives of Deerfield Academy. Submission of your application acknowledges the following: The information on this application is true, complete without any significant omission or correct. I authorize Deerfield Academy to investigate my past employment, education, and activities and I release Deerfield Academy and all persons, companies, and corporations supplying such information from any and all liability that could arise from this release of information. I understand that false answers, statements or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge. I understand that if I am offered a job, this offer is fully contingent upon the satisfactory completion of all aspects of Deerfield Academy's pre-placement screening process which will include, but is not limited to a physical examination and a Criminal Offender Background Investigation. Name First Last If you agree to the conditions of this application, please type the code listed below, in the text box below.