EMPLOYMENT APPLICATION _ Instructional

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PERSONAL INFORMATION

Last Name *

First Name *

Street Address *

City *

State *

Zip Code *

Email Address *

CellPhone Number *

Alternative Phone Number *

POSITION

Which position/s are you applying for? *

Academic Teacher

Instructional Assistant

ECA Teacher

Which grade level are you most comfortable with? *

What subject area or extra curricular activity are you applying for? *

PURPOSE

Why do you want to work at Sipnayan Afterschool Program? *

0/300 words

Why do you think should Sipnayan Afterschool Program hire you? *

0/300 words

What is your educational philosophy? *

0/300 words

What is your philosophy in managing student behavior? *

0/300 words

How important is parent involvement to you and will you encourage parent participation? *

0/300 words

What do you think is the teacher's role to ensure that students attend the program regularly? *

0/300 words

EDUCATION

High School *

Year Graduated *

City *

State *

Post-Secondary (Start from the most recent.)

	School	Degree	Major	Year Graduated
1)	School	Degree	Major	Year Graduated
2)	School	Degree	Major	Year Graduated
3)	School	Degree	Major	Year Graduated

EXPERIENCE

List all experiences related to the position you are applying for.

	Job Title	Years of Exp.	Employer
1)	Job Title	Years of Exp.	Employer
2)	Job Title	Years of Exp.	Employer
3)	Job Title	Years of Exp.	Employer
4)	Job Title	Years of Exp.	Employer
5)	Job Title	Years of Exp.	Employer

Describe the details of your experience working with children. *

0/500 words

QUALIFICATIONS, AWARDS, HONORS

Please list all valid teaching certificates that you currently hold.

	Subject Area	Grade Level	Type	Expiration
1)	Subject Area	Grade Level	Type	Expiration
2)	Subject Area	Grade Level	Type	Expiration
3)	Subject Area	Grade Level	Type	Expiration

Please list and describe all awards and honors that you have received. *

0/500 words

REFERENCES

Please list three (3) references below according to its description. Each of the reference below will receive a link to complete the reference form.

	Name	Organization	Email	Phone
1) Current Supervisor	Name	Organization	Email	Phone
2) Former Supervisor	Name	Organization	Email	Phone
3) Personal or Colleague	Name	Organization	Email	Phone

WORK AUTHORIZATION

Only US citizens and aliens with legal documents to work in the United States are eligible for employment. If you are not a US citizen, Sipnayan Math Center and Afterschool program will require a copy of your Employment Authorization Document (EAD), Permanent Resident Card (green card), or any other visa that authorizes you to work with ANY US employer.

I certify that I am legally authorized to work in the United States under the authorization chosen below. *

If you chose "other", please write the type of visa that you have.

BACKGROUND CHECK

IMPORTANT! It is a 21st CCLC program requirement that all employees, service contractors and volunteers who work with the program have approved criminal background check. The center will run the following background check before hiring:

NC Sex Offender Database and National Sex Offender Database
Statewide Criminal Background Check including all states in which the employee or volunteer lives or has lived for the previous five (5) years.

Please note that individuals convicted of any kind of felony and/or any offense involving sexual or physical abuse/neglect against a child are strictly prohibited from working with the 21st CCLC Program.

Please type your initial across each statement.

	Initial
1) I authorize Sipnayan Math Center and Afterschool Program LLC to conduct an investigation of my background using the NC Sex Offender Database and the National Sex Offender Database.	Initial
2) I authorize Sipnayan Math Center and Afterschool Program LLC to conduct a national criminal background check to include all states in which I live or have lived in the past 5 years.	Initial
3) I understand that if I was found convicted of any kind of felony and/or any offense involving sexual or physical abuse/neglect against a child, I will not be eligible to work with the 21st CCLC Program run by Sipnayan Math Center and Afterschool Program LLC.	Initial
4) I understand that my social security number is necessary to run an accurate criminal background check. For the security of my personal information, I understand that this information will not be collected online. Therefore, I agree to provide my Social Security number via phone to Sipnayan's HR representative.	Initial

First Name *

Last Name *

MI *

List all other names that were used previously. Please use one box for each former name.

+-

DL State *

DL Number *

Expiration Date * +

Date of Birth * +

List ALL addresses in the last 5 years starting on the current address.

	Street	City	State	From-To (Year)
1)	Street	City	State	From-To (Year)
2)	Street	City	State	From-To (Year)
3)	Street	City	State	From-To (Year)

Applicant Signature *

clear

Thank you for completing the application. We will let you know of the next steps in the process once your application is reviewed. Thanks!