Teacher
Application and Information
Date_____________
Name
_________________________________AKA___________________Birth
date_____________
Address__________________________________________________Zip_______________________
Phone # Home ____________________
other ____________________________________________
Emergency contact:
______________________________________Phone ______________________
E-mail address______________________________________________________________________
PLEASE LIST AND DISCUSS IN DETAIL:
(use the back if necessary)
1. Teaching areas and age levels with which you feel most
competent.
2.
Places and
Dates of your
past experience with above activities: education, employment, personal
experience, etc.
3. The full weeks (M– F) or Tuesday and/or
Thursday evenings when you will be available for possible teaching
assignments between June 4 and August 10, 2007.
4. Reference
(not a relative or former employer)
Name____________________________________________
Address:
Phone
Numbers:
5.
SS#____________________________________
I certify that my answers are true and
complete to the best of my knowledge. I authorize you to make such
investigations and inquiries of my personal, employment, or educational history
and other related matters as may be necessary for an employment decision. I
hereby release employers, schools or persons from all liability in responding to
inquiries in connection with my application.
In the event I am employed, I understand
that false or misleading information given in my application or interviews may
result in discharge.
Signature:______________________________________________
Date: ______________________
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