Employment Application

Name*

Street Address:

City:

State:

Mobile No:

Phone No:

Email

Must ensure that you have working Email.

Check Appropriate Items

Application Type

New ApplicationPrevious Application On FileFormer Employee of Division

Position(s)

Current Position

Current Employer

Phone Number

Date Available

Why Do You Plan To Leave Current Position?

Professional Applicants Must Hold Or Be Eligible For A Valid Virginia License Appropriate To Employment Position

Virginia License Type and License Number

Endorsements

Expiration Date

Out of State License Type and License Number

Endorsements

Expiration Date

Please Have Copies Of Scores Sent

Praxis I Date Taken

Reading Score

Math Score

Writing Score

Praxis II Date Taken

Subject Area

Score

NTE Date Taken

Specialty Area

Score

Check If you have completed the following:

Technology StandardsChild Abuse Recognition and Intervention TrainingFirst Aid, CPR, and AED Training

List Any Colleges or Universities From Which Degrees Were Awarded. Official Copies Of Transcripts Are Required.

High School

State

Field of Study

Degree Type

Year of Graduation

College (Bachelor's)

State

Field of Study

Degree Type

Year of Graduation

College (Master's)

State

Field of Study

Degree Type

Year of Graduation

College (Other)

State

Field of Study

Degree Type

Year of Graduation

Career Switcher Program

State

Field of Study

Degree Type

Year of Graduation

Name of School

City/County

State

Grade Levels/Subject Area

Dates

Name Of School

City/County

State

Grade Levels/Subject Area

Dates

List Chronologically All Full-Time Teaching and Educational Administrative Experience. Do Not Include Substitute Teaching.

Name of School

City/County

State

Grade Levels/Subject Area

Dates

Name Of School

City/County

State

Grade Levels/Subject Area

Dates

Name Of School

City/County

State

Grade Levels/Subject Area

Dates

Name Of School

City/County

State

Grade Levels/Subject Area

Dates

Employer

City/County

State

Type of Work

Dates

Employer

City/County

State

Type of Work

Dates

Employer

City/County

State

Type of Work

Dates

Employer

City/County

State

Types of Work

Dates

Branch of Service

Military Specialty

Inclusive Dates

Type of Discharge

Reserves

YesNo

It is your responsibility to have three (3) professional references sent to the Personnel Manager, 2329 Chestnut Avenue, Suite A, Buena Vista, VA 24416. Your application will not be made active until reference letters have been received. Applicants currently registered with a college or university placement service may have a placement file sent in lieu of reference forms.

Full Name

First NameLast Name

Position/Relationship

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Full Name

First NameLast Name

Position/Relationship

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Full Name

First NameLast Name

Position/Relationship

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Please provide any other information which you believe will provide additional understanding of your qualifications.

Organizations or Professional Memberships

Awards, Honors, or Recognitions

Reports, Articles, or Books Published

Special Professional Assignments

Volunteer Work

Please list any sports or other extracurricular activities you would be interested in coaching or sponsoring. Please include years and types of previous experiences.

Please Check Yes or No. Provide explanations.

Are you a United States Citizen?

YesNo

If No, please explain.

If you ARE NOT a United States citizen, do you have documentation to be eligible for employment in the United States?

YesNo

Have you ever been discharged or requested to resign from an employed position?

YesNo

If Yes, please explain.

Have you ever been refused renewal of an employment contract?

YesNo

If Yes, please explain.

Have you ever been convicted of a violation of law (other than a minor traffic offense)?

YesNo

If Yes, please explain.

Have you ever been convicted of child abuse or child molestation?

YesNo

If Yes, please explain.

Has your FBI/State Criminal Record been approved

YesNo

READ: By signing and submitting this application, I authorize the school division to conduct a background investigation and authorize release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal and professional references, and other appropriate sources. I waive my right of access to any such information, and without limitation hereby release the school division and the reference source from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: the local Sheriff/Police Department, information from the Central Criminal Records Exchange of either data on all criminal convictions or certification that no data on criminal convictions are maintained, information from the Virginia or other State Department of Social Services Child Protective Services Unit and any locality to which they may refer for release of information pertaining to any finding of child abuse or neglect investigations involving me.

Furthermore, I certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application, and I understand that any omission, falsely answered statement made by me on this application, or any supplement to it will be sufficient grounds for failure to employ or for my discharge should I become employed with the school division. *

Signature

Clear

MonthDayYearHourMinutesAM/PM Option

Attachments

This application will remain on file for one year. It is your responsibility to notify the Central Office on or before October 1 of the ensuing year if you wish to be considered for employment beyond that date. The Buena Vista City Public School Division is committed to a policy of nondiscrimination on the basis of race, color, national origin, religion, sex, disability, or age in the administration of any of its educational program activities, or with respect to employment. *

Buena Vista City Public Schools, 2329 Chestnut Avenue, Suite A, Buena Vista, Virginia 24416 | 540-261-2129 | FAX 540-261-2967

Buena Vista City Public Schools

Permanent Address

Application/Position Information

Current Employment

Professional Certificate or License

Teacher Exam Scores

Educational and Professional Training

Student Teaching Experience

Student Teaching Experience

Teaching Experience

Other Work Experience

Military Experience

Professional References

Other Information

Coaching/Extracurricular Interests

Board of Education Required Questions

Read and Sign