Columbia Academy Application for Employment:

If you would like to upload your resume, please do it here.
(allowed file types: doc,docx,pdf)
* Name (First Name, Middle Name, Last Name):
Maiden Name (if applicable):
* Address:
* City:
* State:
* Zip:
* Telephone Number:
* Are you legally eligible for employment in the United States?
Yes   No
* Position(s) applied for:
Will you accept employment that is:
Full Time   Part Time   Temporary
* Date you are available to start work:
Salary or wages desired:
* Have you worked for CA before?
Yes   No
If yes, when and what position did you hold?
* Church Membership: Of what congregation are you a member?
* Congregation: City/State
* Do you drink alcohol?
* Do you use tobacco?
Indicate any special qualifications or skills:

EDUCATION

* Name and Location of High School
* Did you graduate from high school?
Yes   No
Name and Location of College/University
College Course of Study
* Did you graduate from college?
Yes   No
* What is the highest level of education you have completed?
High School   Some college
Associates   Bachelors
Masters   Doctorate/Professional
* Are you employed at the present time?
Yes   No
* If hired, will you work overtime if required?
Yes   No
* Have you ever been convicted of a crime (other than a minor traffic violation)?
Yes   No
If yes, list convictions: (A conviction does not necessarily disquality an applicant for the position).

WORK EXPERIENCE (start with the most recent employer. Include any student teaching.)

#1 Employer:
City/State:
Employer Phone:
Duties:
Are you employed at this time?  If not, reason for leaving:
Month/Year Begin:
Month/Year End:
Position:
Principal or Supervisor's Name:
Starting Salary/Wages:
Final Salary/ Wages:
#2 Employer:
City/State:
Employer Phone:
Duties:
Reason for leaving:
Month/Year Begin:
Month/Year End:
Position:
Principal or Supervisor's Name:
Starting Salary/Wages:
Final Salary/Wages:
#3 Employer:
City/State:
Employer Phone:
Duties:
Reason for leaving:
Month/Year Begin:
Month/Year End:
Position
Principal or Supervisor's Name:
Starting Salary/Wages:
Final Salary/Wages:
#4 Employer:
City/State:
Employer Phone:
Duties:
Reason for leaving:
Month/Year Begin:
Month/Year End:
Principal or Supervisor's Name:
Stating Salary/Wages:
Final Salary/Wages:
Explain fully any gaps in your employment history:
* Have you ever been terminated, asked to resign, or had an employment contract not renewed? If yes, please explain.

MILITARY SERVICE

Branch of Service:
Month/Year Begin:
Month/Year End:
Rank & Duties:
Date Discharged:
Honorable
Yes   No

REFERENCES

Include at least one educational reference and one Elder or Minister

* Type of Reference:
Professional   Personal
* Name:
* Organization:
* Relationship:
City/State:
* Years Known:
* Phone:
* Email:
* Type of Reference:
Professional   Personal
* Name:
* Organization:
* Relationship:
City/State:
* Years Known:
* Phone:
* Email:
* Type of Reference
Professional   Personal
* Name:
* Organization:
* Relationship:
City/State:
* Years Known:
* Phone:
* Email:

ADDITIONAL INFORMATION

TN Teacher Certificate Number:
Date Issued:
Date Expires:
Certified for Grades:
Areas of Certification:
Teacher Certification from what other States?
* Have you had any teacher certificate suspended or revoked?
Yes   No
If yes, Why?
Other areas with 12 or more college credit hours:
Subjects you prefer to teach:
Grades you prefer:
Sports you could coach:
Activities you could sponsor:

The information submitted is true and complete to the best of my knowledge.  Should I be employed by the School, any misrepresentation or false statement contained herein may be considered cause for possible dismissal.  The School, in compliance with the provisions of the Fair Credit Reporting Act of Sept. 1997, may contact directly or employ the services of investigative agencies to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history, or credit standing.  I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the School.

I understand this application does not constitute an employment contract of any kind.  Should I be employed by the School, I may resign such employment at any time at my discretion with or without notice, unless a separate school written contract is executed and the School may terminate my employment at any time at their discretion, with or without cause and with or without prior notice, unless a separate school written contract is executed.

ELECTRONIC SIGNATURE

The electronic signature and related fields below are treated by Columbia Academy like a physical handwritten signature on a paper form.

* Check for electronic signature
(1 required)
Yes
* Name:
* Date:
* Email Address: