EMPLOYMENT APPLICATION

POSITION APPLYING FOR: *

Lead Teacher
Teacher's Aide
Office Staff
Before & After Care Staff
Substitute Teacher

APPLICANT'S PERSONAL INFORMATION

Application Date: *

Available Start Date:

Name *

First

Middle

Last

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Cell

Evening

Have you: (please answer all questions)

been convicted of a felony

been dismissed from a teaching position

been asked to resign from a teaching position

been refused continuing employment as a teacher

had a teaching license revoked

has a report of child abuse or sexual misconduct involving a minor filed against you in a school district, Children's Services, a police agency, or in court

If you answered "yes" to any above the above, please explain:

Gifts/Talents

Are you interested, gifted, or qualified in any of the following areas?

Art
Music: Vocal/Instrumental
Speak a second language
Physical Education
Other

Please briefly explain:

CHRISTIAN BACKGROUND/BELIEFS

Are you a Christian? *

Name of Church you attend *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Pastor's Name

Contact Number

EDUCATION/TRAINING/EXPERIENCE

List degrees, licenses, and certificates you hold. (check all that apply)

Education

High School Diploma or GED

Date Received

Associate Degree

Date Received

(copy) (copy)

Bachelor's Degree

Date Received

(copy)

Master's Degree

Date Received (copy)

Training/Certificates

Date Received

MAT Certified

Date Received

Other Training/Certfications

Date Received

Licenses (list date received):

EMPLOYMENT HISTORY

Detail each position held the past five years and account for any gaps in employment during that period. (Please start with current employment).

Position

Dates of Employment

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name *

First

Last

Phone

May we contact your present employer?

Position

Dates of Employment

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name

First

Last

Phone

Reason for leaving

Position

Dates of Employment

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name

First

Last

Phone

Reason for leaving

Position

Dates of Employment

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name

First

Last

Phone

Reason for leaving

PERSONAL REFERENCES

Please provide references (include 3 from the categories below):

Former Supervisor:

Phone

Former Co-worker:

Phone

Your Minister/Pastor

Phone

Parent of a Student

Phone

Other (must be a non-relative)

Phone