application for employment date received ___ method received _ response...

Application for EmploymentApplication for Employment

Date Received _______________

Method Received _____________

Response Letter Date __________

Interview Date________________

New Employment Process•Attach Resume & Copyof College Transcript•Attach a copy of any certifications•Submit Application•Applicant will normally receive written notification from PCCA•If necessary, additionalinformation may berequired•If approved, applicantwill receive an interview with appropriate staff•If approved, applicantwill be required to submit to a background check and potentially a drug test•Upon approval and passing all background checks, applicant will receive notification ofemployment & contract

Applicant Information Name____________________________ Preferred Name_______________________Social Security Number __________________________________________________Street Address________________________________ City___________ Zip________Home Phone___________________________ Cell Phone_______________________Are you 18 years or Older? Yes NoEmail Address _________________________________________________________Are you currently married? _________________ How Long? ___________________

Desired Employment: Please place a 1,2,3 in order of desired placement. ( ) Grammar School (K-4th) ( ) Logic School (5th-8th) ( ) Rhetoric School (9th-12th)Electives Only (Specify):_________________________________________________List Specific Courses You are Interested in Teaching: _______________________________________________________________________________________________Are you currently employed? ____May we contact your current employer? ________Date you can start at Providence Academy? _____________Education

High School:Name of School: ___________________________________________________City: _________________________________ State: ______________________Did You Graduate? _______________ Year Diploma Received: _____________

College (Undergraduate):Name of School: ___________________________________________________City: _________________________________ State: ______________________Did You Graduate? _______________ Year Degree Received: ______________GPA:_______________

College (Graduate):Name of School: ___________________________________________________City: _________________________________ State: ______________________Did You Graduate? _______________ Year Degree Received: ______________GPA:_______________

Other: ______________________________________________________________________________________________________________________________

Raising Up the Next Generation for the Kingdom…

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Former Employers(List below last three employers, starting with the most recent one first.)Name of Present/Last Employer________________________________________________________Address________________________________ City_______________ State______ Zip__________Starting Date_________________ Leaving Date___________________ Job Title________________Starting Salary___________ Ending Salary__________ May we contact your supervisor__________Name of Supervisor__________________ Title________________ Phone_____________________

Description of Work_________________________________________________________________________________________________________________________________________________

Reason for Leaving _________________________________________________________________________________________________________________________________________________


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Description of Work ________________________________________________________________ _________________________________________________________________________________

Reason for Leaving: _________________________________________________________________________________________________________________________________________________


Description of Work ________________________________________________________________ _________________________________________________________________________________

Reason for Leaving: _________________________________________________________________________________________________________________________________________________

Background Information

Please list all certifications (education, trade, associations) current or expired that you hold:________________________________________________________________________________________________________________________________________________________________

Have you ever been convicted of a felony or misdemeanor?_________ If yes, please explain on aseparate document.Have you been terminated with any company or from any position?_______ If yes, please explain______________________________________________________________________________________________________________________________________________________________

Please describe any serious illnesses that you currently are experiencing or have experienced in thepast that could interfere with your ability to perform the job description. ________________________________________________________________________________________________________________________________________________________________

If you have taught or instructed at a school in the past, have you ever had your contract not renewedfor any reason?_______ If yes, please explain___________________________________________________________________________________________________________________________

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ReferencesPersonal Reference:Name__________________ Email Address_____________________ Phone___________ How Long____

Professional Reference:Name__________________ Email Address_____________________ Phone___________ How Long____





Church Membership Currently At_______________________________ How Long___________Describe Involvement and activities at Church___________________________________________________________________________________________________________________________________________________________________________________________________________Church Pastor:Name_______________ Email Address_____________________ Phone___________ How Long____

Personal Information

On a separate document, please provide your Testimony.

Please describe your philosophy of Christian Education: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How do you promote Christian values in your home______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Professional Organizations/Hobbies/Activities

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Statement of Faith

Are there any points of the PCCA Handbook which are inconsistent with you? ___________ If yes, please explain ________________________________________________________________________________________________________________________________________________

Service Record

Branch of Service __________________________________________ Discharge Date __________Rank ________________________________ Honorable Discharge Yes NoIf No, please explain _______________________________________________________________________________________________________________________________________________



Authorization“I certify that the facts contained in this application are true and complete to the best of my knowledgeand understand that if employed, Falsified statements on this application shall be grounds for dismissaland criminal prosecution.I authorize investigation of all statements contained herein and the references and employers listedabove to give you any and all information concerning my previous employment and any pertinentinformation they may have, personal or otherwise and release Providence from all liability forany damage that may result from utilization of such information.”

Signature___________________________________ Date__________________________________

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Do not write below this line

Office CommentsInterviewed by_____________________________________________________________________Date_____________________________________Comments_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do not write below this lineOffice CommentsInterviewed by_____________________________________________________________________Date_____________________________________Comments_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student Non-Discrimination PolicyProvidence Classical Christian Academy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities made available to students of the school. It does not discriminate on the basis of race, color, gender, national and ethnic origin in the administration of its educational policies, admissions policies, financial assistance, athletics, or any other school administered programs.



Mail Information to: Providence Academy, P.O. Box 173, Lowell, AR 72745

Staff Non-Discrimination PolicyProvidence Classical Christian Academy does not discriminate on the basis of race, color, gender, national and ethnic origin in the administration of its hiring process.

Providence Classical Christian Academy

AUTHORIZATION FORINVESTIGATIVE REPORT

I understand that Providence Classical Christian Academy, a private K-12 school, will request a criminal background check through National Crime Search, Inc. (NCS). I further understand that neither Providence Classical Christian Academy nor NCS may give out information about me to anyone without my written consent. The report may contain a record of arrests and/or convictions for violations of any federal, state, local statutes or ordinances. I forever release, absolve, and indemnify to the fullest extent allowed by law Providence Classical Christian Academy, NCS, its affiliates, and all providers of information for releasing and obtaining any information arising from any and all sources.

I hereby authorize Providence Classical Christian Academy and NCS to obtain a criminal background report. I have read and understand the above statements and hereby give my express permission to complete this investigation.

______________________________________________ ____________________________

Signature Today’s Date

______________________________________________ ____________________________

Full Legal Name (please print) Aliases (please print)

_____________________________________ __________________________________

Address City/State Zip

__________________ ____________________ _____________________ ___________

Date of Birth SSN Driver’s License # State issued

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application for employment date received _______________ method received _____________ response...

Documents

application for employment date received ___ method received _ response...