Full Name
*
First Name
Last Name
Age
*
Date of Birth
*
MM
DD
YYYY
Email Address
*
Phone Number
*
(###)
###
####
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
T-shirt Size
*
S
M
L
XL
2XL
Highest Level of Education
*
High School Diploma or GED
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Name of Institution, Degree Earned, and Year of Completion.
*
Are You Currently in School?
*
Yes
No
Please List Any Certificates, Certifications, or Licenses that you have earned.
Are You Currently Employed?
*
Yes
No
Which position are you applying for?
*
Helpdesk Support Specialist
IT Help Desk Team Lead
Program Expansion Partner
City-wide Tech Camp Instructor
Which days are you available to work? (check all that apply)
*
Though we cannot guarentee that the shifts will meet your availability, we will do our best to place you in a shift that matches your work preferences.
Monday
Tuesday
Wednesday
Thursday
Friday
Which timeframe best matches your availability?
Though we cannot guarentee that the shifts will meet your availability, we will do our best to place you in a shift that matches your work preferences.
9am-5pm (only select if applying to a full-time position)
2pm - 6pm
4pm - 8pm
Neither timeframe works with my availability
Consent for Name & Image Release
*
I hereby consent to the reproduction, publication, and other uses of my photographic or cinematic images, voices and/or property by Black Boys in Tech, BBIT Digital, and any programs of these organizations, however designated. I further consent to the use of the above-mentioned cinematic images or photographic likeness in any motion picture, television broadcast, advertisement, publication, online mediums, or programs at such time and in such places as the above-named organizations, separately or in partnership, and in their individual and joint discretion, shall determine. I also consent to the irrevocable right to use our names (and any fictional name), written copy and photograph for purposes outlined as in the above paragraph. I further grant the above-mentioned rights without compensation.
I hereby give my consent for the Name & Image Communications Release.
I do not give my consent for the Name & Image Communications Release.
Consent for Background Check
*
I hereby consent to have my name, date of birth, ID number, and social security number to be used by Black Boys in Tech for the purpose of conducting a background check.
I do not consent to a background check.
Applicant Signature
*