Employment Application – Grace Community School

Name

First Last

SSN

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long have you lived at the above address?

Phone

Position(s) applying for

Qualifications

Hours avaliable to work?

Full-time/Part-time

Full-time
Part-time

US Citizen?

Yes
No
Authorized to work in US

Date of Birth

Marital Status

Single
Married
Divorced
Widowed

Do you have children?

Yes
No

How many children?

Children's Age(s)

Is there anything in your background that would disqualify you from being a caretaker of young children?

Yes
No

Please explain

Do you agree to be fingerprinted as required by state law?

Yes
No

Do you have any reoccurring illnesses or other difficulties that would make it hard to perform duties in a childcare/school care setting?

Yes
No

Please explain

Would it be unreasonable to ask you to perform any of the following duties: mop a floor, sweep the room, take garbage out to the dumpster, move furniture and curriculum in your classroom or pick up a child to carry out of the building if necessary?

Yes
No

Please explain

Have you ever been arrested or convicted of any criminal act?

Yes
No

Please explain

Have you ever been reported for child abuse or neglect?

Yes
No

Please explain

Education

Have you completed high school?

Yes
No

When

Have you completed college?

Yes
No

When

What degrees do you hold?

Date you received?

Receiving Institution

Other training or education?

Are you familiar with A Beka Christian curriculum?

Yes
No

Why do you want to work in a Christian school?

Are you a Christian?

Yes
No

Do you attend church?

Yes
No

Have you ever helped a church ministry?

Yes
No

Do you plan to go back to school for further training?

Yes
No

What are your life goals for the next 5 years?

Employment History

Employer

From Date

To Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Salary (hourly rate)

Duties

Reason for leaving

Employer

From Date

To Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Salary (hourly rate)

Duties

Reason for leaving

Employer

From Date

To Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Salary (hourly rate)

Duties

Reason for leaving

References

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What level do you prefer to teach?

Employment Agreement*

I agree

I hereby certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that discovery of falsification of any statement or an omission of fact may prevent me from being hired or if hired, may subject me to immediate dismissal. If I am released under these circumstances, I further understand that I will be paid and received benefits only through the day of release. I authorize Grace Community School to thoroughly investigate references, work records, education and other matters related to my suitability for employment. I authorize references and my former employers to disclose to the school any and all information related to my life and employment, without giving me prior notice. Since I will be working with children, I understand that I must submit to a fingerprint check by the FBI and possibly other federal or state authorities. I authorize Grace Community School to conduct a criminal records check. I agree to attend additional training if necessary for my job in the evening or on weekends. I understand that Grace Community School does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, gender, age or disability.

Authorization to Release Reference Information*

I agree

I authorize Grace Community School to thoroughly investigate references, work records, education and other matters related to my suitability for employment. I authorize references and my former employers to disclose to the school any and all employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure. In addition, I hereby release Grace Community School, my former employers, references, and all other parties from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I waive the right to ever personally view any references given to Grace Community School. I certify that I have carefully read and do understand the above statements.