KeySource Job Application Form

Job Application

Please complete the form below to apply for a position with us.
Full Name *

First Name Middle Name Last Name
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address *
Phone Number

Area Code Phone Number

Education

	Highest Level of Education Completed
High School
College
Graduate School
Certified Teacher
Other

Applying for Position *
Please rank the grade level range you prefer: (K-4, 5-6, 7-8, 9-12)
What are your strongest academic areas?

Math English/Language Arts Science Social Studies Arts Physical Education/Health
List any work experience, interests, skills,or activities that you feel would make you an effective professional:
Are you interested in summer employment during Extended School Year (ESY)?

Yes No
Possible Start date

Month Day Year

General Background Information

	Yes	No
Were you ever convicted of a criminal offense?
Are you currently under charges for a criminal offense?
Have you ever forfeited bond or collateral in connection with a criminal offense?
Within the last ten years, have you been fired from any job after being notified that you would be fired?
Have you ever been professionally disciplined in any state? (Professional disciplined mans the annulment, revocation or suspension of any certification or having received a letter of reprimand from an agency, board or commission of state government, such as the Pennsylvania Professional Standards and Practices Commission)
Are you subject to any visa or immigration status, which would prevent lawful employment?

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