UPCA Employment Application

Name*

First NameLast Name

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

Email*

Phone Number*

Grade Level Preferred*

Elementary (K-4)Middle (5-8)High School (9-12)

Subjects Preferred*

Available Start Date*

How did you hear about Union Pointe Academy?*

I am interested in...(please choose all that apply):*

Full-TimePart-TimeSubstituteOrton-Gillingham Tutor

Best Method of Contact*

EmailPhone

Background Information*

	Yes	No
Are you a citizen of the United States?
Are you subject to any via or immigration status, which would prevent lawful employment? If yet, please explain in notes below.
Have you ever had a professional certificate revoked or suspended? If yes, please explain in notes below.
Have you ever been convicted of a violation of law other than a minor traffic violation? If yes, please explain in notes below.
Are you currently under investigation or pending charges for a criminal offense? If yes, please explain in notes below.
Have you ever been involuntarily terminated or asked to resign, or resigned in lieu of termination? If yes, please provide date and reason for resignation or termination in notes below.

Notes for Background Information:

High School

Name*

City, State*

Dates Attended*

Degree Achieved and Date*

College/Institution #1

Name*

City, State*

Dates Attended*

Degree Achieved and Date*

College/Institution #2

Name

City, State

Dates Attended

Degree Achieved and Date

College/Institutuion #3

Name

City, State

Dates Attended

Degree Achieved and Date

Do you currently hold a valid Kentucky Teaching Certificate or one from any other state?*

YesNo

If you answered "yes" to holding a teaching certificate, please indicate the state in which the certification is held and the expiration date.

If you answered "no" to holding a valid teaching certificate, have you ever held a certificate that may now be expired? If so, please indicate the state in which the certification is held and the expiration date.

Please list any additional certifications or trainings you possess, relevant to teaching.

Please explain your philosophy of education.*

What specialized talents or qualifications do you posses that will benefit our school community?*

Branch

Rank at Discharge

Dates of Service

Type of Discharge

HonorableDishonorable

Current/Most Recent Employer

Job Title*

Employer*

Supervisor's Name, Email, Phone #*

Position Start/End Date*

Reason for Leaving*

Responsibilities*

Employer #2

Job Title

Employer

Supervisor's Name, Email, Phone #

Position Start/End Date

Reason for Leaving

Responsibilities

Employer #3

Job Title

Employer

Supervisor's Name, Email, Phone #

Position Start/End Date

Reason for Leaving

Responsibilities

Professional Reference #1

Name*

Relationship*

Length of Relationship*

Email*

Professional Reference #2

Name*

Relationship*

Length of Relationship*

Email*

Personal Reference

Name*

Relationship*

Length of Relationship*

Email*

UPA stands firm on the following foundational truths: We believe the Bible is the inspired, infallible, authoritative Word of God written under the inspiration of the Holy Spirit. We believe there is one God eternally existent in three persons - God the Father, the Son and the Holy Spirit. We believe in the deity of Jesus Christ, His virgin birth, His sinless life, His crucifixion and atoning death and glorious resurrection. We believe in His ascension to the right hand of the Father and His second coming. We believe that our salvation comes by God’s grace alone when we put our faith and trust in Jesus Christ as Lord and Savior.

I support the statement above in its entirety.*

YesNo

If you answered "no" to the statement above, please list and explain any areas in which you disagree.

The school does not discriminate on the basis of race, color, national origin age, sex or disability, for admission, or access to, or treatment or employment in its programs and activities.

I affirm that all information set forth in this application is accurate, truthful and complete. If I am employed, I will abide by all policies, work on assigned tasks for Union Pointe Academy, and continue my professional growth to the best of my ability and within reasonable and personal standards. I grant permission for school officials to obtain a criminal record check. I give authorization to interview references which I have listed. I release individuals listed as references and current or former employers from any liability for information given in response to a request for an employment reference.

In the event, that I am employed and in the further event that I have provided false or misleading information in this application or in subsequent employment interviews, I understand that my employment may be terminated at any time after the discovery of the false or misleading information. I will and agree that I will be paid only thorugh the day of release. I understand that this is only an application fo remployment and that no employment offer has been made at this time. This application will be considered active for one year from date of submission.

I certify that I have carefully read and do understand the above statements. Signature:*

Date*

UPCA Employment Application

Education Background

Teaching Credentials

Military Background

Employment History

References

Christian Beliefs

Applicant's Agreement