APPLICATION FOR EMPLOYMENT

Position in which you are applying:*

TeacherCounselorBehavior SupportOther

Desired Salary

Name*

First NameLast Name

Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Phone*

Please enter a valid phone number.

Emergency Contact

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number.

Emergency Contact Email

example@example.com

Are you eligible to work in the United States?*

Have you ever been convicted of any violent felony set forth in the definition of a barrier crime listed in The Code of Virginia subsection A § 19.2-392.02; of any offense involving the sexual molestation, physical or sexual abuse, or rape of a child; or any crime of moral turpitude?" *

Have you ever been the subject of a founded case of child abuse and neglect?" *

Are you 18 years or older?*

Do you have a valid driver's license?*

If a former employee of Elite Academy, please list dates of employment and reason for leaving.

If related to any current Elite Academy employees, please list their name and relationship to you.

Do you have a high school diploma or GED?*

Do you have a college degree?*

If yes, indicate your highest level of degree and field of study.*

Field of Study*

Field of Study

Are you currently licensed as a teacher, counselor, or social worker in the state of Virginia?*

If yes, please list type of license.

If licensed, please list area(s) of endorsement.

Area(s) of Endorsement

License Number:

License Number

Please list any additional licenses or certifications you hold.

Licenses or Certifications

If available, please upload a copy of your license(s) or certification(s).

Please list any skills you possess relevant to the position for which you are applying.

Skills

1. Job Title and Primary Duties:

Employer Name and Address:

Dates of Employment and Reason for Leaving:

Please list name of supervisor or appropriate reference from this job.

Supervisor/Reference Name

Supervisor/Reference Email

example@example.com

Supervisor/Reference Phone

Please enter a valid phone number.

2. Job Title and Primary Duties:

Employer Name and Address:

Dates of Employment and Reason for Leaving:

Please list name of supervisor or appropriate reference from this job.

Supervisor/Reference Name

Supervisor/Reference Email

example@example.com

Supervisor/Reference Phone

Please enter a valid phone number.

3. Job Title and Primary Duties:

Employer Name and Address:

Dates of Employment and Reason for Leaving:

Please list name of supervisor or appropriate reference from this job.

Supervisor/Reference Name

Supervisor/Reference Email

example@example.com

Supervisor/Reference Phone

Please enter a valid phone number.

4. Job Title and Primary Duties:

Employer Name and Address:

Dates of Employment and Reason for Leaving:

Please list name of supervisor or appropriate reference from this job.

Supervisor/Reference Name

Supervisor/Reference Email

example@example.com

Supervisor/Reference Phone

Please enter a valid phone number.

5. Job Title and Primary Duties:

Employer Name and Address:

Dates of Employment and Reason for Leaving:

Please list name of supervisor or appropriate reference from this job.

Supervisor/Reference Name

Supervisor/Reference Email

example@example.com

Supervisor/Reference Phone

Please enter a valid phone number.

6. Job Title and Primary Duties:

Desired Salary

Employer Name and Address:

Dates of Employment and Reason for Leaving:

Please list name of supervisor or appropriate reference from this job.

Supervisor/Reference Name

Supervisor/Reference Phone

Please enter a valid phone number.

Please list name of most recent supervisor or appropriate reference.*

Supervisor/Reference Name

Supervisor/Reference Email*

example@example.com

Supervisor/Reference Phone*

Please enter a valid phone number.

Please list name of most recent supervisor or appropriate reference.*

Supervisor/Reference Name

Supervisor/Reference Email*

example@example.com

Supervisor/Reference Phone*

Please enter a valid phone number.

You may attach reference letters here.

I certify that the information on this application is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Elite Academy to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a criminal background investigation and/or screening for illegal substances upon conditional offer of employment. I understand this document is NOT an offer of employment and an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand employees of Elite Academy serve at-will and the employment relationship may be terminated at any time by either party, for any or no reason, other than a reason prohibited by law.

If employed, I will be required to furnish proof of eligibility to work in the United States and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. I understand any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand the first SIX MONTHS of regular employment represent a provisional period during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.

Signature

APPLICATION FOR EMPLOYMENT

EDUCATION

WORK EXPERIENCE

REFERENCES

SIGNATURE