New Vision Teacher Application Form

Position for which you are applying (check all that apply)*

Middle SchoolSubstitute Teachers

Full Name*

First NameMiddle NameLast Name

Home Phone Number

Please enter a valid phone number.

Work Phone Number

Please enter a valid phone number.

Cell Phone Number*

Please enter a valid phone number.

Email*

example@example.com

High School Name

Graduated?

YesNo

College/University Name #1*

Major*

Degree Obtained*

College/University Name #2*

Major

Degree Obtained

Job Experience

Please include

Dates Employed (Month/Year - Month/Year)
Position
Employer Name
Employer Address

Experience #1 (most recent)*

Supervisor Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Experience #2*

Supervisor Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Experience #3

Supervisor Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Experience #4

Supervisor Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Please explain any gaps in employment

References (minimum of three)

References #1 ( Name, position/job title, phone number)*

Email Address-Reference #1 *

example@example.com

References #2 ( Name, position/job title, phone number)*

Email Address-Reference #2*

example@example.com

References #3 ( Name, position/job title, phone number)*

Email Address-Reference #3*

example@example.com

References #4 ( Name, position/job title, phone number)*

Email Address-Reference #4*

example@example.com

List degrees, honors, commendations, elective or appointive offices held, or other distinctions received.

HONORS AND DISTINCTIONS

BACKGROUND INFORMATION

Are you, or have you ever been, listed on a sex offender registry?*

YesNo

Are you, or have you ever been, listed on a child or dependant adult abuse registry?*

YesNo

Have you ever been found guilty, accepted a guilty, or entered a plea of no-contest for any criminal charge?*

YesNo

Have you ever received a deferred judgment, or in some other way had a guilty plea or conviction removed from your record?*

YesNo

If you answered “yes” to any of the above questions, provide date, incident, specific charge, city/state in which occurred:

Have you ever been asked to resign from a position, or been given the choice of resigning or being terminated from your position?*

YesNo

Have you ever been the subject of an investigation or other formal/informal proceeding that resulted in the termination of your employment or resignation?*

YesNo

Have you ever been the subject of an investigation into wrong doing or other formal/informal proceeding, resulting in disciplinary or criminal action?*

YesNo

Briefly explain any “yes” response(s):

Responding "yes" to any of the previous questions is not an automatic bar to employment. The date of the offense and the relationship between the offense or infraction and the position for which you are applying will be considered.

Are you legally eligible to work in the United States?*

YesNo

Are you able to perform with or without reasonable accommodation, the essential job functions required of the position?*

YesNo

Do you wish to be considered for veteran’s preference?*

YesNo

IF YES, PLEASE FILL OUT NEXT SECTION

Military Duty

Active Duty

(mm / yy)

To

(mm / yy)

Branch

Location of Duty

Rank at Discharge

Type of Discharge

Reserve Duty

(mm / yy)

To

(mm / yy)

Branch

Obligation

Times of Current Training Day

AGREEMENT (Read carefully before signing or submitting electronically)

By my signature:

• I acknowledge that individuals who provide false, inaccurate, or incomplete information in the application form, in an interview, or any other part of the hiring process or who fail to disclose information requested in the application form, in an interview, or any other part of the hiring process will not be eligible for employment, or, if they are hired, they will be subject to termination.

• I acknowledge that to the fullest extent permitted by state and federal law, the New Vision will consider all information concerning an applicant or an employee in making hiring, termination, and other employment-related decisions. The term "all information" includes information of any kind (verbal, written, photographic, videographic, etc.) that is accessible in any medium (print, electronic, etc.) from any source.

• I acknowledge that New Vision will consider public information and other information to which it has lawful access. This may include information that is contained in social networking sites, blogs, and other electronic sites, such as YouTube. If there is information that pertains to me that I believe requires explanation, interpretation, or clarification when it is considered by New Vision, it is my obligation to communicate this information to New Vision.

• I authorize New Vision to conduct a complete check regarding my background including, but not limited to, criminal record, child and dependent adult abuse registry screening, and sex offender registry. I agree to prepare and sign any other form necessary to complete a criminal background check. I further authorize all government agencies departments, bureaus, or related entities to release any and all information regarding my criminal history, if any. I agree to immediately notify New Vision if I should be convicted of any crime while my application is pending, or during my period of employment if hired.

• I authorize all current and former employers, teachers, and references to release all information regarding my professional competence, performance, character, and background. I waive any right I may have against any person contacted as a reference concerning this application.

• I acknowledge that information that is relevant to New Vision’s decisions will be considered regardless of the date on which New Vision obtains the information and regardless of the date on which the information was first published, created, or made accessible to New Vision.

• I understand that this application will be considered active for twelve (12) months from the date filed. I further understand that if I am employed by New Vision Schools, this application and associated documents will become part of my permanent record.

• I understand that this application is not a contract of employment. In accepting the position, if hired, I understand that employment is at will unless otherwise specified by the state of Mississippi. I acknowledge that New Vision may discharge an at-will employee at any time for any legal reason or no reason at all.

• I agree to submit to both pre-employment and post-employment random drug and alcohol testing. (Note: This only applies to Bus Drivers as required by the State.)

Do you currently hold a valid Teachers License with appropriate endorsement for the position you are applying for?*

YesNo

Teaching License Number

Please list your endorsements:

Are you currently under contract for any school district next year?*

YesNo

Please upload resume.*

Please upload cover letter.*

By my electronic submission of this form:

• I attest that all the information contained in this application is accurate, complete, and true.

• I am bound by all elements of the agreement section of the application.

• I understand and accept that electronic submission will be considered equivalent to an original hand written signature on a paper copy of the application.

Name*

First NameLast Name

Date*

Date

1.Applicants, and/or their designees, are asked not to contact members of the Board of Directors during this search process.

2. Screening for this position will continue until the position is filled.

3. In order to be considered for this position, your application materials must include the following:

Completed application form (including signatures)
Resume
References (at least 3)
A copy of (or documented evidence of eligibilty) a current teachers license and endorsements
Photocopy of college/university transcripts
Background Check

New Vision Schools will select for employment qualified applicants for each position without improper discrimination on the basis of race, color, creed, religion, sex, sexual orientation, gender identity, national origin, ethnic background, age, or disability. Persons with disabilities who can perform the essential functions of an assignment with or without reasonable accommodation shall be considered qualified applicants. New Vision shall take affirmative action in the recruitment, appointment, assignment and advancement of personnel to accomplish the goals of equal employment opportunity. In keeping with the law, New Vision shall consider the veteran status of applicants.

Teacher Application

Personal Information