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Professional Job Application

Application for Professional Employment

Dillard Academy Charter Public School

Personal Information

First Name*

Answer required for "First Name"

Middle/Maiden

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Last Name*

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Address

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City

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Street

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Zip Code

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Phone Number*

Number Required

Cell Number

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Office

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Email Address*

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Birthdate*

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How long you lived at this address: From/Date

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Until/Date (Type present if still living in this address)

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Social Security

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Date available for employment

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Please state briefly your reason for wanting to teach here at Dillard Academy Charter School

Answer required for "Please state briefly your reason for wanting to teach here at Dillard Academy Charter School"

US Citizen*

Answer required for "US Citizen"

Yes

No (If not, choose one down below)

Type of Residence (please attach documentation)

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Resident Alien

Non-Resident Alien

Documents related to type of residency

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Choose a file or drag it here.

Race*

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White

Black

Hispanic

Asian

Native Hawaiian/Pacific Islander

American Indian/Alaskan Native

Positions for which application is being made (be specific): Applicant must be licensed or eligible for license in each area of choice. Examples: K-6, MS Science, Exceptional Children, Speech, Principal, etc.

First Choice*

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Second Choice

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Third Choice

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Cover Letter and Resume*

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Professional Licensure

It is your responsibility to obtain and maintain your license in a current status. Please note that individuals qualifying for a North Carolina license based on reciprocity with another state are required to meet North Carolina’s NTE/Praxis II requirements.

Do you hold a NC Professional License?*

Answer required for "Do you hold a NC Professional License?"

Yes (If yes, please enclose a copy and complete the information regarding to license issuing)

No (If no, please enclose a copy of all college transcripts)

Date License Issued*

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Date Effective*

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Date Expires

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Upload any documents regarding to licensing, transcripts, etc*

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References (if not listed on resume)

Each applicant must provide the following information to be considered for employment at Dillard Academy Charter School:

A. List the names of at least three references. Include current employer if employed, or last employer if not currently employed. References from relatives or persons who can only evaluate your personality and character are not acceptable references. Those who have known you for at least four years and/or are substantially familiar with your education achievements and work history are preferred.

B. Applicants who are beginning teachers, registered with a college placement office, must include references from their student teaching supervisor(s) and cooperating teachers in the placement file and list names below.

Name of Reference #1

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Position

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Email Address

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Work Phone

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Home Phone

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Name of Refernce #2

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Position

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Email Address

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Work Phone

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Home Phone

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Name of Reference #3

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Position

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Email Address

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Work Phone

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Home Phone

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May we contact your present employer?

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Yes

Not Applicable

Employment Record

Name of Employer

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Date Employed

Answer required for "Date Employed"

Date Seperated

Answer required for "Date Seperated"

Starting Salary

Answer required for "Starting Salary"

Ending Salary

Answer required for "Ending Salary"

Supervisor's Name

Answer required for "Supervisor's Name"

Duties (briefly describe duties)

Answer required for "Duties (briefly describe duties)"

Name of Employer

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Date Employed

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Date Seperated

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Starting Salary

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Ending Salary

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Supervisor Nmae

Answer required for "Supervisor Nmae"

Duties (briefly describe duties)

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Additional Information

Have you ever been asked to resign from a position of employment or been dismissed, fired, discharged, suspended, or otherwise subject to disciplinary actions?*

Answer required for "Have you ever been asked to resign from a position of employment or been dismissed, fired, discharged, suspended, or otherwise subject to disciplinary actions?"

Yes

Have you ever had a teaching license of certificate suspended or revoked?*

Answer required for "Have you ever had a teaching license of certificate suspended or revoked?"

Yes

Have you ever been convicted due to any violation of the law other than a minor traffic ticket?*

Answer required for "Have you ever been convicted due to any violation of the law other than a minor traffic ticket?"

Yes

Have you ever entered a plea of nolo contendere (No Contest) to any charge against you?*

Answer required for "Have you ever entered a plea of nolo contendere (No Contest) to any charge against you?"

Yes

Do you have any criminal charges pending against you or are you currently involved in any criminal proceeding, including supervised or unsupervised probation?*

Answer required for "Do you have any criminal charges pending against you or are you currently involved in any criminal proceeding, including supervised or unsupervised probation?"

Yes

If you answered yes to any of the above questions, please explain under this response

Answer required for "If you answered yes to any of the above questions, please explain under this response"

Driver's License/State ID Number*

Answer required for "Driver's License/State ID Number"

State

Answer required for "State"

Class

Answer required for "Class"

Expiration Date*

Answer required for "Expiration Date"

Please list below those school activities in which you are interested and which you are qualified to supervise, coach, or direct. Please be specific about coaching experience. Us another page if needed. Other Interests/Hobbies

Answer required for "Please list below those school activities in which you are interested and which you are qualified to supervise, coach, or direct. Please be specific about coaching experience. Us another page if needed. Other Interests/Hobbies"

Nepotism Policy

1. To avoid nepotism, no staff member that is an immediate family member of a member of the Board of Directors or the chief administrator shall be hired without the board of directors evaluating their credentials, establishing a structure to prevent conflicts of interest, and notifying the Department of Public Instruction with evidence, that this process hasoccurred.

Person #1

Answer required for "Person #1"

Relationship

Answer required for "Relationship"

Person #2

Answer required for "Person #2"

Relationship

Answer required for "Relationship"

Person #3

Answer required for "Person #3"

Relationship

Answer required for "Relationship"

Applicant's Certification & Release of Liability

I, the undersigned applicant/employee hereby expressly authorize the Dillard Academy Board of Education, its agents, and its employees to make any investigation of my personal or employment history, expressly including, but limited to, federal and/or state criminal law enforcement, or traffic record, which may include confirmation by fingerprint identification. I further authorize any former employer, person, firm, corporation, credit agency, administrative body, or governmental agency to give the Board of Education, its agencies, or its employees any information they may have regarding me in consideration of the review of my employment application by the Board of Education, its members, officers, agents, or its employees. I hereby release the Board of Education to which that application is submitted any and all providers of information, of information to whom this release is sent, from any liability as a result of furnishing or receiving this information. If employed, I further authorize this Board of Education or its agents to provide information about my employment in this school system to future employers or prospective employers. I authorize persons to whom an exact copy of this release is presented to rely on the copy as if it were a signed original.

I have read the information contained in the application carefully and certify that the information I have given is correct and complete. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal.

Signature*

Signature Required

Name: Date:

Sign this form

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Signature *

Type to sign

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Full Name *

Date:

Confirmation Email

Confirmation Email *

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