St. Peter's Employment Application Form

POLICY

St. Peter's Episcopal School does not discriminate on the basis of race, color, national origin, sex, handicap, gender or age in its employement practices as required by Title VI of the Civil Rights Act of 1064, as amended; Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975, as amended; and Section 504 of the Rehabilitation Act of 1793, as amended.

Date of Application

Date

Name Of Applicant

First NameMiddle NameLast Name

Other name that may appear on records. Ex. Maiden name (used for reference and background checks)

First NameLast Name

Current Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Phone Number

Area CodePhone Number

Home Phone Number

Area CodePhone Number

Email Address

example@example.com

Are you currently employed or under contract

If yes, where?

Have you previously been employed by St. Peter's Episcopal School?

Dates:

May we contact your present employer for a recommendation?

Position Desired:

Attributes: (select all that apply)

Expected Salary Range:

EDUCATIONAL BACKGROUND

Official transcripts of all completed college/university coursework should accompany this application.

High School Name, Address, Dates Attended

College/University Name, Address, Dates Attended

Degree Received:

Name of Degree Received

Did you attend another college/university?

College/University Name, Address, Dates Attended

Degree Received:

Name of Degree Received

Did you attend another college/university?

College/University Name, Address, Dates Attended

Degree Received:

Name of Degree Received

Major Area (Undergraduate)

Type N/A if not applicable

Minor Area (Undergraduate)

Type N/A if not applicable

Did you have another degree?

Major Area (Graduate)

Minor Area (Graduate)

Type N/A if not applicable

Please list other degrees/certifications:

Please select the highest education level that you have completed:

Do you have a license to teach in the state of Tennessee:

If No, are you in an Alternative Certification Program?

Do you have an Out-of-State Educator Certificate:

If yes, please list Educator Certificate, Teaching Fields, Effective Date and Expiration Date

Student Teaching History

District/Company, Supervisor, Phone, Position Held, Dates

WORK HISTORY - Please provide consecutive Work History beginning with the most recent.

Current/Most Recent Employment: Company Name, Supervisor, Phone number or Email, Position Held, Dates

Reason for leaving:

May we contact this employer?

Previous Employer: Company Name, Supervisor, Phone number or Email, Position Held, Dates

Type N/A if not applicable

Reason for leaving:

May we contact this employer?

Previous Employer: Company Name, Supervisor, Phone number or Email, Position Held, Dates

Type N/A if not applicable

Reason for leaving:

May we contact this employer?

Previous Employer: Company Name, Supervisor, Phone number or Email, Position Held, Dates

Type N/A if not applicable

Reason for leaving:

May we contact this employer?

PROFESSIONAL DATA

Please list relevant professional activities. Omit references to organizations that would reveal race, age, ethnic origin, or religion.

GENERAL INFORMATION

Are you legally authorized to work in the United States for our Company?

Do you now, or will you in the future, require sponsorship for employment visa status (e.g., H-1B visa status, etc.) to work legally for our Company in the United States?

If presently employed, why do you wish to leave?

What date would you be available to start work?

Have you ever been refused tenure or a continuing contract? If yes, please explain.

Have you ever had a license or certificate revoked or suspended? If yes, please explain.

Have you ever been discharged or requested to resign from any position? If yes, please explain.

Have you ever been convicted of a misdemeanor or felony in any court of law and/or received probation or deferred adjudication?

Have you ever been convicted of a felony? If yes, please explain.

Do you have criminal charges or proceedings pending against you? If yes, please explain.

Do you have a relative who serves on the St. Peter's Episcopal School Board? If yes, please provide the relatives name and relationship.

How did you hear about the position? Were you referred by any of our staff or student family members? If yes, please provide the name and relationship.

REFERENCES

List the names and email/phone number of at least three persons, not related to you, who can speak with knowledge of your personal and professional qualifications for the assignment which you seek. Teaching applicants with work experience must provide recommendations from principals and/or superintendants from all contracted educational work experiences within the past 3 years. If experience was not within the past three years, provide references from last c ontracted experience. Beginning teachers must include references from their student teaching supervisor(s) and cooperating teacher(s).

1st Reference

First NameLast Name

1st Reference Employer

1st Reference Phone Number

Area CodePhone Number

1st Reference Email

example@example.com

2nd Reference

First NameLast Name

2nd Reference Employer

2nd Reference Phone Number

Area CodePhone Number

2nd Reference Email

example@example.com

3rd Reference

First NameLast Name

3rd Reference Employer

3rd Reference Phone Number

Area CodePhone Number

3rd Reference Email

example@example.com

APPLICATION AGREEMENT

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations or ommissions of fact may be grounds from rejection of my application or dismissal from subsequent employment.

I authorize the references listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.

I understand that the school is authorized by Tennessee Education Code 49-6-3001(c)(3)(A)(iii) to obtain criminal history record information on applicants the school intends to employ.

Please sign to agree to these terms. This application becomes the property of St. Peter's Episcopal School upon signature. The school reserves the right to accept or reject it. This application shall be considered active for a period not to exceed two years. Any applicant wishing to be considered for employment beyond this time period may not inquire as to whether or not applications are being accepted at that time.

Please upload resume, certifications, licenses, and any educational transcripts you have.

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Today's Date

Date

Have you been convicted of a crime?

If convicted, describe the crime(s) and the particulars of the conviction(s) in the space below:

I am a current or prospective:

Signature