Employment Application Form

Date

MM

DD

YYYY

Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Have you ever been found guilty, accepted a guilty, or entered a plea of no-contest for any criminal charge? *

Yes

No

Graduated?

Yes

No

Graduated?

Yes

No

Do you currently hold a valid Teachers Certification License with appropriate endorsement for the position you are applying for? *

Yes

No

Additional Information Required: *

Name and Contact Details of Current Pastor:

First Name

Last Name

Phone *

(###)

###

####

Former Supervisor *

First Name

Last Name

Phone *

(###)

###

####

Personal Character Reference *

First Name

Last Name

Phone *

(###)

###

####

Are you legally eligible to work in the United States?

Yes

No

AGREEMENT *

(Read carefully before signing or submitting electronically) By my signature: • I acknowledge that individuals who provide false, inaccurate, or incomplete information in the application form, in an interview, or any other part of the hiring process or who fail to disclose information requested in the application form, in an interview, or any other part of the hiring process will not be eligible for employment, or, if they are hired, they will be subject to termination. • I acknowledge that to the fullest extent permitted by state and federal law, Rochester Christian School will consider all information concerning an applicant or an employee in making hiring, termination, and other employment-related decisions. The term "all information" includes information of any kind (verbal, written, photographic, videographic, etc.) that is accessible in any medium (print, electronic, etc.) from any source. • I acknowledge that Rochester Christian School will consider public information and other information to which it has lawful access. This may include information that is contained in social networking sites, blogs, and other electronic sites, such as YouTube. If there is information that pertains to me that I believe requires explanation, interpretation, or clarification when it is considered by Rochester Christian School, it is my obligation to communicate this information to the Principal. • I authorize Rochester Christian School to conduct a complete check regarding my background including, but not limited to, criminal record, child and dependent adult abuse registry screening, and sex offender registry. I agree to prepare and sign any other form necessary to complete a criminal background check. I further authorize all government agencies, departments, bureaus, or related entities to release any and all information regarding my criminal history, if any. I agree to immediately notify Rochester Christian School if I should be convicted of any crime while my application is pending, or during my period of employment if hired. • I authorize all current and former employers, teachers, and references to release all information regarding my professional competence, performance, character, and background. I waive any right I may have against any person contacted as a reference concerning this application. • I understand that this application will be considered active for twelve (12) months from the date filed. I further understand that if I am employed by Rochester Christian School, this application and associated documents will become part of my permanent record. • I understand that this application is not a contract of employment.

Yes

No

By my electronic submission of this form: *

• I attest that all the information contained in this application is accurate, complete, and true. • I am bound by all elements of the agreement section of the application. • I understand and accept that electronic submission will be considered equivalent to an original hand written signature on a paper copy of the application.

First Name

Last Name