St. Peter's Employment Application Form

POLICY

St. Peter's Episcopal School does not discriminate on the basis of race, color, national origin, sex, handicap, gender or age in its employement practices as required by Title VI of the Civil Rights Act of 1064, as amended; Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975, as amended; and Section 504 of the Rehabilitation Act of 1793, as amended.

Date of Application*

Date

Name Of Applicant*

First Name Middle Name Last Name

Other name that may appear on records. Ex. Maiden name (used for reference and background checks)

First Name Last Name

Current Address:*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Mobile Phone Number*

Area Code Phone Number

Home Phone Number

Area Code Phone Number

Email Address*

example@example.com

Are you currently employed or under contract*

YesNo

If yes, where?*

Have you previously been employed by St. Peter's Episcopal School?*

YesNo

Dates:*

May we contact your present employer for a recommendation?*

YesNoContact Me First

Position Desired:*

Attributes: (select all that apply)*

Expected Salary Range:*

EDUCATIONAL BACKGROUND

Official transcripts of all completed college/university coursework should accompany this application.

High School Name, Address, Dates Attended*

College/University Name, Address, Dates Attended*

Degree Received:*

YesNo

Name of Degree Received*

Did you attend another college/university?*

YesNo

College/University Name, Address, Dates Attended*

Degree Received:*

YesNo

Name of Degree Received*

Did you attend another college/university?*

YesNo

College/University Name, Address, Dates Attended*

Degree Received:*

YesNo

Name of Degree Received*

Major Area (Undergraduate)*

Type N/A if not applicable

Minor Area (Undergraduate)*

Type N/A if not applicable

Did you have another degree?*

Yes - Master'sYes - OtherNo

Major Area (Graduate)*

Minor Area (Graduate)*

Type N/A if not applicable

Please list other degrees/certifications:

Please select the highest education level that you have completed:*

Bachelor's DegreeMaster's DegreeDoctorate Degree

Do you have a license to teach in the state of Tennessee:*

YesNo

If No, are you in an Alternative Certification Program?*

YesNo

Do you have an Out-of-State Educator Certificate:*

YesNo

If yes, please list Educator Certificate, Teaching Fields, Effective Date and Expiration Date

Student Teaching History*

District/Company, Supervisor, Phone, Position Held, Dates

WORK HISTORY - Please provide consecutive Work History beginning with the most recent.

Current/Most Recent Employment: Company Name, Supervisor, Phone number or Email, Position Held, Dates*

Reason for leaving:*

May we contact this employer?*

YesNo

Previous Employer: Company Name, Supervisor, Phone number or Email, Position Held, Dates*

Type N/A if not applicable

Reason for leaving:*

May we contact this employer?*

YesNoN/A

Previous Employer: Company Name, Supervisor, Phone number or Email, Position Held, Dates*

Type N/A if not applicable

Reason for leaving:*

May we contact this employer?*

YesNoN/A

Previous Employer: Company Name, Supervisor, Phone number or Email, Position Held, Dates*

Type N/A if not applicable

Reason for leaving:*

May we contact this employer?*

YesNoN/A

PROFESSIONAL DATA

Please list relevant professional activities. Omit references to organizations that would reveal race, age, ethnic origin, or religion.

GENERAL INFORMATION

Are you legally authorized to work in the United States for our Company?*

Do you now, or will you in the future, require sponsorship for employment visa status (e.g., H-1B visa status, etc.) to work legally for our Company in the United States?*

If presently employed, why do you wish to leave?

What date would you be available to start work?*

Have you ever been refused tenure or a continuing contract? If yes, please explain.*

Have you ever had a license or certificate revoked or suspended? If yes, please explain.*

Have you ever been discharged or requested to resign from any position? If yes, please explain.*

Have you ever been convicted of a misdemeanor or felony in any court of law and/or received probation or deferred adjudication?*

YesNo

Have you ever been convicted of a felony? If yes, please explain.*

Do you have criminal charges or proceedings pending against you? If yes, please explain.*

Do you have a relative who serves on the St. Peter's Episcopal School Board? If yes, please provide the relatives name and relationship.*

How did you hear about the position? Were you referred by any of our staff or student family members? If yes, please provide the name and relationship.*

REFERENCES

List the names and email/phone number of at least three persons, not related to you, who can speak with knowledge of your personal and professional qualifications for the assignment which you seek. Teaching applicants with work experience must provide recommendations from principals and/or superintendants from all contracted educational work experiences within the past 3 years. If experience was not within the past three years, provide references from last c ontracted experience. Beginning teachers must include references from their student teaching supervisor(s) and cooperating teacher(s).

1st Reference*

First Name Last Name

1st Reference Employer*

1st Reference Phone Number

Area Code Phone Number

1st Reference Email

example@example.com

2nd Reference*

First Name Last Name

2nd Reference Employer*

2nd Reference Phone Number

Area Code Phone Number

2nd Reference Email

example@example.com

3rd Reference*

First Name Last Name

3rd Reference Employer*

3rd Reference Phone Number

Area Code Phone Number

3rd Reference Email

example@example.com

APPLICATION AGREEMENT

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations or ommissions of fact may be grounds from rejection of my application or dismissal from subsequent employment.

I authorize the references listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.

I understand that the school is authorized by Tennessee Education Code 49-6-3001(c)(3)(A)(iii) to obtain criminal history record information on applicants the school intends to employ.

Please sign to agree to these terms. This application becomes the property of St. Peter's Episcopal School upon signature. The school reserves the right to accept or reject it. This application shall be considered active for a period not to exceed two years. Any applicant wishing to be considered for employment beyond this time period may not inquire as to whether or not applications are being accepted at that time. *

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Please upload resume, certifications, licenses, and any educational transcripts you have.

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ADDENDUM TO APPLICATION

St. Peter's Episcopal School is required by state law to obtain criminal history record information on all applicants that are being seriously considered for employment with the school. Tennessee Education Code Section 0520-2-3.21 The information requested below is necessary to obtain criminal history record information.

Maiden or other name

First Name Last Name

Date of birth*

Date

Sex*

MaleFemale

Height*

Weight*

Hair Color*

Eye Color*

Race*

Place of Birth*

Country of Citizenship*

Driver's License Number*

Driver's License State*

Social Security Number (no dashes)*

I understand that the information that I am providing about age, sex or any other personal and historic information will not be used to determine eligibility for employment to the position for which I am applying, but will be used solely for the purpose of obtaining criminal history record information as mandated by the laws of Tennessee. *

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Today's Date*

Date

Have you been convicted of a crime?*

I have been convicted of a crime.I have not been convicted of a crime.

If convicted, describe the crime(s) and the particulars of the conviction(s) in the space below:*

I am a current or prospective:*

EmployeeVolunteerContractor/Vendor

Signature*

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