Teacher Application

Position for which you are applying *

Full Name *

First Name Middle Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail

Home Phone Number

Work Phone Number

Cell Phone Number

High School Name

Years Attended

Graduated?

Yes No

College Name

Years Attended

Graduated?

Yes No

Degree / Major

Trade or Correspondence School

Years Attended

Graduated?

Yes No

Degree / Major

Teaching Experience

Please include dates employed, Employer name, address and phone number, Position, Salary, Wage,

Supervisor's name and phone number, and your reason for leaving.

Most recent position - Company Name, Email, Phone & Dates of Employment

Most recent position - description of job

Second recent position - Company Name, Email, Phone & Dates of Employment

Second most recent position - description of job

Third recent position - Company Name, Email, Phone & Dates of Employment

Third most recent position - description of job

Fourth recent position - Company Name, Email, Phone & Dates of Employment

Fourth most recent position - description of job

Please explain any gaps in employment

Other Relevant Experience

Please list any other experience you have, including dates, employer name address and phone number, position,

salary, supervisor's name and phone number, and reason for leaving.

Experience #1

Experience #2

Experience #3

Please list four individuals who are very familiar with your professional work and character who may be contacted. Please include their name, position, business phone, home or cell phone, and address.

References *

Are you a Christian? *

Yes No

Briefly tell us about your experience / relationship with Christ *

Do you attend church regularly? *

Yes No

What is the name of the church that you attend? *

Why do you want to work with little children? What qualities do you possess that qualify you for this job? *

BACKGROUND INFORMATION

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

Yes No

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

Yes No

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

Yes No

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

Yes No

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? *

Yes No

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

Yes No

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

Yes No

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? *

Yes No

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

Yes No

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.

Resume or other documentation upload

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Date *

Personal Infromation