Website Victory Autism Academy Employment Application

Position for which you are applying *

Teacher Support Staff (Support Teacher or Behavior Coach) Custodial/Maintance Office Staff Administration Van Driver

Campus

VAA Elementary VAA Junior High/High School Either Campus

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email *

example@example.com

Phone Number *

Please enter a valid phone number.

Fingerprint Clearance Card-Every VAA Employee must obtain a valid IVP Fingerprint Clearance Card within 30 days of employment. If you have already started the process/have a card, please fill in the information below. If not, HR will give you instructions on how to obtain a card.

CPR/First Aid Certification-Every VAA Employee must be First Aid/CPR Certified. If you are already certified, please provide the expiration date below. If you still need to be certified, HR will give you information on obtaining certification. This must be completed within 30 days of hire.

Are you CPI-Crisis Prevention Intervention Certified? If not and it is applicable to your position, we will schedule your training.

Company/Position prior to Victory Autism Academy *

Start/End Date (if no end date, put start date - current) *

Educational Background

Prior Experience

Explain any gaps in employment:

Honors/Distinctions-List any honors, commendments, elective or appointive offices held, or other distinctions received.

Reference 1

Reference 2

Reference 3

Have you ever been convicted of a violation of law other than a minor traffic violation? (The term "conviction" includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilt by a jury or judge.)

Have you ever been terminated or discharged, or resigned at the request of your employer from any job related to K-12 education?

Have you ever resigned in lieu of being terminated?

In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?

Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?

Has there been an incident that could affect your ability to work/teach in this school?

Resume

Authorization Signature - Please read carefully and then sign your name if you agree to the terms of this understanding. I herby certify that the statements made by me in this application and all related information which I have provided are true, accurate, and complete to the best of my knowledge. I understand that if I provide any false, inaccurate, or incomplete information, I will not be eligible for employment, or if I am hired, I will be subject to disciplinary action or dismissal regardless of the date on which the District discovers the violation of its policy regarding application form dishonesty. *

Clear

Date *

Date

Website Lead Victory Autism Academy Employment Application