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General Information:
Last Name: * First Name: * MiddleName:
Email: *                                       Confirm Email:*
Address:
Address: * Apt: City: * State: * Zip: *

Are over the age of 18?

Yes   No

Cell Phone Number: * (including area code)
( ) -

Alternate Phone Number: (including area code)
( ) -

Type of Position Desired: *

Location:

Starting Salary Expected:
Availabilty Schedule: *

Monday   Tuesday   Wednesday   Thursday  
Friday   Saturday   Sunday  

Availabilty Date:
  


Are you a certified teacher? Yes No

Are you currently emolyed by district school system? Yes No

Educational Background:

Name of
School
Location
Did you Graduate?
Diploma/Degree
Major
High School
Yes No
College
Yes No
If not how many semesters did you complete?
Post Graduate
Yes No
Other
Yes No
Levels Taught:
Preschool
K-2
3-5
6-8
Not Applicable

Have you ever been convicted of or pleaded guilty to any criminal offense (before a court or by military court martial)? Yes No
If “yes” please explain:


Prior to employment, your responses will be verified by a criminal record check if you are selected to continue forward in the hiring process. Conviction of a criminal offense does not automatically bar a person from employment at Salientlearning Factors such as federal, state or local statutory requirements, the relationship of the offense to employment, the length of time since the offense and the seriousness and nature of the violation will be taken into account.

Federal, state, and/or local law prohibits discrimination in hiring and employment on the basis of age, color, disability, marital status, national origin, race, religion, sex, veteran status, citizenship, or other legally protected categories.

EMPLOYMENT HISTORY:
Salientlearning reserves the right to verify all information including salary.
List all periods of employment, including any military service, for the last ten years (or last four employers). Start with your most recent positions and note any periods of unemployment. Be sure to sign the bottom of this page.
 May we contact your present employer? Yes No
Employer 1
Present or last employer:
  Date (Mo/Yr)
From:
To:
Current or last position: Salary (start/final)
Address: Immediate Supervisor: Telephone:
Duties:

Reason for leaving:

Employer 2
Present or last employer:
  Date (Mo/Yr)
From:
To:
Current or last position: Salary (start/final)
Address: Immediate Supervisor: Telephone:
Duties:

Reason for leaving:

Employer 3
Present or last employer:
  Date (Mo/Yr)
From:
To:
Current or last position: Salary (start/final)
Address: Immediate Supervisor: Telephone:
Duties:

Reason for leaving:

Employer 4
Present or last employer:
  Date (Mo/Yr)
From:
To:
Current or last position: Salary (start/final)
Address: Immediate Supervisor: Telephone:
Duties:

Reason for leaving:

References:
Individuals qualified to give an opinion of your ability and experience
 
Name/Relationship Employer Position Address & Telephone
 
Upload your Updated Resume:
(file should be a .pdf or .doc file)     
Please read the following statements carefully. We will consider you for employment after you sign this application. Typing your name in the box below shall constitute your signature.
terms text

Please type your full name below.

Signature: * Date: 09/04/2010

  
 

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