APPLICATION FOR EMPLOYMENT

3355 Mission Ave #123 Oceanside, CA 92058

Phone: 760-529-4975

Oceanside Therapy Group, Inc. is an equal opportunity employer. All decisions regarding recruiting, screening,
hiring, training, promotion, transfer, pay, training, benefits and other conditions of employment will be made
based on valid job qualifications and business reasons. All such decisions will be made without discrimination
due to any characteristic or condition protected by federal state, or local law.
PLEASE PRINT
POSITION(S) APPLIED FOR: DATE OF APPLICATION:
Full-time Speech Language Pathologist- CFY 8/27/18

HOW DID YOU LEARN ABOUT US?

 ADVERTISEMENT  FRIEND (Name) ________________________________  WALK-IN

 EMPLOYMENT AGENCY  RELATIVE (Name) ______________________________ X OTHER __Personal research__
Last Name First Name Middle Name/Initial
Mondak Jordan D

Street Address City State Zip Code Telephone Number(s)

7922 Amber Jam Way Berrien Springs MI 49103 269-252-3173

Email Address Alternate Telephone Number(s)

mondakjordan@gmail.com

Identify any other names you have been known or are known by:

yes
If under the age of 18, can you provide proof of your eligibility to work? N/A.........................................................................  no 
yes
Have you ever filed an application with us before?.....................................................................................................................  no X If yes, date ________
yes
Have you ever been employed with us before?...........................................................................................................................  no X If yes, date ________

 yes
Are you currently employed?....................................................................................................................................................... no X

yes
May we contact your present employer? N/A.............................................................................................................................  no 

Are you legally authorized to work in the United States? (Proof of legal authorization to work in the United States
X
will be required upon employment)............................................................................................................................................. yes no 
Are you available to work: Minimum salary required:

X Full–Time  Temporary  Part-Time  Other Per Hours $ 25.00__ Per Month $ 5,500.00_

On what day would be you available for work? Hours available to work?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8-6 8-6 8-6 8-6 8-6

X
Can you travel if a job requires it?............................................................................................................................................... yes no 
Are you mentally or physically able to perform the essential functions of the job for which you are applying, with or
X
without reasonable accommodation(s)?....................................................................................................................................... yes 
no

 yes
Have you ever had military training related to the job for which you are applying?.................................................................. no X
If “yes” please describe
 UNDERGRADUATE
EDUCATION ELEMENTARY SCHOOL HIGH SCHOOL GRADUATE/PROFESSIONAL
COLLEGE /UNIVERSITY
School Name and Location Village SDA, Berrien Andrews Academy, Berrien Andrews University, Berrien Andrews University, Berrien
Springs, MI Springs, MI Springs, MI Springs, MI
Years Completed
4 5 6 7 8 9 10 11 12 1 2 3 4 1 2 3 4
Diploma/Degree College Preparatory Bachelor of Science Masters of Science

Describe course of study: Speech Language Pathology Speech Language Pathology

Describe any specialized training, apprenticeship, skills, and extra-curricular activities:

I am certified in Lee Silverman Voice Treatment (LSVT) and MBSImp (Videofluoroscopic training). I have gained much experience working with kids through volunteer
programs such as after-school tutoring, mission trips to Belize and Haiti (organizing youth programs), and volunteering at Camp Pals, a week long summer program for
young adults with Down syndrome. I have a passion for serving those who are overlooked in society and put my leadership skills to use by organizing a homeless ministry
in Chicago, IL. Specific skills I have that would benefit your clinic is experience with Augmentative and Alternative Communication (AAC) devices. My ability to adapt
and be flexible with any type of client that I am presented with is a strength of mine. Clinical experience includes a 6 week internship at Mercy Health Hospital in Grand
Rapids, MI in the acute care setting with adults and elderly. 9 week internship at Read Elementary in Bridgeport, CT working with children 4-12 years old. 12 week
internship at Siskin Children’s Institute in Chattanooga, TN working with a variety a disabilities in children ages 1.5-13 years old. During my 12 week internship I gained
much experience working with children on the autism spectrum along with children who were non-verbal and implementing AAC devices.

Describe any honors you have received: During my undergraduate years I was inducted into Phi Kappa Phi, I also received Outstanding Student Award for Speech
Language Pathology: Excellence in Academics, Service and Leadership. Presented April 19, 2016. I was also awarded the Spirit of Andrews Award: One male out of the
entire student body that best represents Andrews University moto: Seek knowledge. Affirm faith. Change the world. Presented 2016.

State any additional information you feel may be helpful to us in considering your application: I am a great team player and can adapt to any role that is in need in your
clinic. I have a love for learning and take constructive feedback very well and will implement into my therapy. I am very personable and have a great strength in building
rapport with clients and their families. My energy and enthusiasm will permeate to the clients along with the staff members.

List professional, trade, business or civic activities and offices held. You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry,
disability or any other protected status: 2016 Class Pastor for the Speech Pathology department. Organized class events, vespers, and after-school tutoring programs.

REFERENCES:
Give Name, Address, Phone of three references who are not previous employers or related to you whom we may contact to discuss your qualifications for employment:

Mallory Hollowell (865) 603-4099 (Clinical supervisor at Siskin Children’s Institute)

________________________________________________________________________________________________________________________________________
Camille Boyd (203) 435-0906 (Clinical supervisor and Read Elementary)
________________________________________________________________________________________________________________________________________
Brynja Davis: (269) 815-2351 (Undergraduate and Graduate professor)
_______________________________________________________________________________________________________________________________________

EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any military service assignments and volunteer activities that are related to the job for which you are applying. You
may exclude organizations which indicate race, color, religion, gender, national origin, sexual orientation, disability or any other protected status under federal,
state, or local law.
EMPLOYER: Andrews University Dates Employed Work Performed/Job Duties: Answering phone calls, setting
From To up therapy appointments, filing paperwork.
Address August, February, 2018
8975 Old 31, Berrien Springs, MI 49104 2016
Telephone Number(s): 269-471-7771

Job/Title: Front desk worker Supervisor: Winona Hayes

Reason for Leaving: Clinical internships

EMPLOYER: Camp Au Sable Christian Youth Camp Dates Employed Work Performed/Job Duties: Head counselor for boys ages
From To 7-17 years old. Teacher for various sports and activities.
Address Summer of Summer of
2590 Camp Au Sable Rd, Grayling, MI, 49738 2015 2016
Telephone Number(s): 989-348-5491

Job/Title Supervisor: Ken Micheff

Head counselor and sports teacher
Reason for Leaving: Graduate school

EMPLOYER: Andrews University: Crayon Box Daycare Dates Employed Work Performed/Job Duties: Teacher aid working with
From To children ages 1-5 years old.
Address: 8975 Old 31, Berrien Springs, MI, 49104 2013 2016
Telephone Number(s): 269-471-3350

Job/Title Supervisor: Kristy Conklin

Teacher Aid
Reason for Leaving: Graduate school

EMPLOYER: Andrews University: F.L.A.G Camp Dates Employed Work Performed/Job Duties: Head counselor for boys ages
From To 7-9 years old. Teacher for various subjects such as Bible,
Science, Outdoor activities
Address: 8655 University Blvd, Berrien Springs, MI, 49103 Summer of Summer of
2011 2013
Telephone Number(s): 269-471-3133

Job/Title: Head Counselor Supervisor: Scott Shalk

Reason for Leaving: New summer job opportunity

Please explain any gaps in your employment history:

_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________

SPECIAL SKILLS/QUALIFICATIONS
Summarize special job-related skills and qualifications acquired from employment or other experience:
Being a head counselor at summer camp, you learn how to manage behavior very well and interacting with 10-15 kids at a time test your patience and positivity. Working
at camp helped me realize I had a gift for working with kids and wanted to pursue a career that involved children. I had the opportunity to teach during summer camps for
kids of all ages and had to adapt the topic based on the age of the children. This prepared me well to modify therapy based on differing factors in children we see at the
clinic. I was also required to be creative in order to engage the kids during these classes which I can carry over into the workplace. My desk job at Andrews University
allowed me to improve my organizational skills by setting up appointments and filing.

Have you ever been terminated from any job? If yes, please explain:
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________

I understand that Oceanside Therapy Group, Inc. may obtain certain public records containing information about me during
the course of its consideration of my application for employment.

X I waive my right to receive a copy of any public records containing information about me.

 I do not waive my right to receive a copy of any public records containing information about me.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may
result in discharge. I also understand that I am required to abide by all rules and regulations of Oceanside Therapy Group,
Inc.

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at
any employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant
wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being
accepted at this time.

I hereby acknowledge that any employment relationship with Oceanside Therapy Group, Inc. is of an “at will” nature,
which means that the, if employed, I may resign at any time and Oceanside Therapy Group, Inc. may discharge me at any
time with or without cause and/or with or without notice. It is further understood that “at will” employment relationship
may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by
the President of Oceanside Therapy Group, Inc.

____Jordan Mondak__________ Date:_____8/27/18______

Signature of Applicant