APPLICATION FOR EMPLOYMENT: PROFESSIONAL STAFF This form must be filled out completely. All information will be treated in a confidential manner. Your application will remain on file for a period of one year unless renewed by your letter or personal call. It is your responsibility to provide transcripts of college credits and evidence of certification, as required by the position for which you have applied, prior to being considered for an interview. PERSONAL INFORMATIONName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email Enter Email Confirm Email Home PhoneBusiness PhoneCell PhonePreferred Means of ContactE-mailHome PhoneBusiness PhoneCell PhonePOSITION DESIREDFor which position are you applying?Please include the area that the position is in. (i.e. Elementary School, Middle School, High School, Counseling, Special Education, Type of Administration, etc.)EMPLOYMENT INFORMATIONList teaching certificates held including endorsements. Are you currently under contract?YesNoWhen does it expire? May we contact your present employer?YesNoN/ASelect N/A if not currently employed.Name PositionPhoneHave you obtained tenure status in any Michigan school district?YesNoWhere?Date Have you ever been denied tenure?YesNoWhere?Why do you wish to leave your present position?Please put N/A if currently not employed.EDUCATIONAL BACKGROUNDNameLocationDates of AttendanceDegreeMajorMinor Must include: High School, Under Graduate School, Graduate Work (if applicable), and any other education.NameLocationDates of AttendanceDegreeMajorMinor Must include: High School, Under Graduate School, Graduate Work (if applicable), and any other education.NameLocationDates of AttendanceDegreeMajorMinor Must include: High School, Under Graduate School, Graduate Work (if applicable), and any other education.Awards, honors or special recognition received:Are you currently working towards a higher degree?YesNoExpected degree:Expected completion date: WORK EXPERIENCE IN EDUCATIONNameLocation of School SystemPositionDatesReason for LeavingLast Salary Total number of years of full-time experience excluding student teaching:OTHER WORK EXPERIENCE (INCLUDING MILITARY)NameLocation of EmployerPositionDatesReason for LeavingLast Salary LIST PRESENT AND PAST MEMBERSHIPS IN PROFESSIONAL ORGANIZATIONSOrganizationDates LIST ANY PRESENT AND PAST VOLUNTARY WORK WITH STUDENTSType of WorkDates Hobbies and Special InterestAre you interested in coaching?NoYesWhich sport?List extra-curricular activities you would be interested in directing.Have you been dismissed from employment or refused re-employment?*NoYesWhy?Have you been convicted of a crime or do you have any felony charges pending?*NoYesWhy?ReferencesList superintendents, principals, and supervisors under whom you have worked and others who have knowledge of your character, personality and ability as a teacher or administrator. Please exclude relatives. *MUST INCLUDE (3) REFERENCES TO BE CONSIDEREDNameTitleAddressE-mailTelephone ESSAYIn your own words, briefly outline your philosophy for teaching.NOTICE TO ALL APPLICANTSBefore any applicant may begin work, the person must be able to verify, under Federal law, that he or she is authorized to work in the United States. All applicants offered a position with the St. Charles Community Schools will have to document their authorization to work before the hiring process will be complete. All applicants are being notified at this time that, if selected for hire, it will be their responsibility to provide the St. Charles Community Schools with documentation showing their right to work. St. Charles Community Schools is giving you this notice so you may have those documents ready if you should be offered a position. The documents will be reviewed by the Personnel Department at the time a conditional offer of employment is made.NOTICE OF HANDICAPPER RIGHTSMichigan law requires that you notify the St. Charles Community Schools in writing within 182 days after you know or should have known that an accommodation for a handicap will be necessary to perform the duties of the position for which you are applying.NOTICE OF MEDICAL EXAMINATIONAny job you are offered by the St. Charles Community Schools will be conditional on the results of a medical examination if requested by the St. Charles Community Schools. The medical exam will be completed before you begin work on your job.APPLICANT'S CERTIFICATION AND AGREEMENTREAD THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION FOR EMPLOYMENT 1. CERTIFICATION OF TRUTHFULNESS: I certify that all statements on this Application for Employment are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false, will be sufficient reason for not being employed or if employed, may result in my dismissal. 2. AUTHORIZATION FOR EMPLOYMENT INFORMATION: I authorize the St. Charles Community Schools to conduct an investigation of me, including but not limited to all statements made by me in this application. I authorize all sources of information (the references I have listed, any prior or current employer of mine or any educational institutions) or anyone else contacted by the St. Charles Community Schools to give it any and all information concerning me and my previous employment or educational accomplishments, including any disciplinary information and any other information they may have, personal or otherwise. I release all sources of information from all liability for any damage that may result from furnishing information to the St. Charles Community Schools. Also, I hereby waive written notice to me that employment information is being provided by any person or organization. A photostatic copy of this Authorization, Release and Waiver shall be considered as effective and valid as the original. 3. PHYSICAL EXAMINATION AND TESTING: I agree to submit myself, upon request, for physical examination by the District’s physician and to execute appropriate releases for that purpose. In addition, I agree to submit to a pre-employment substance screening test and to all searches and substance testing called for by the District’s Drug Free Workplace Policy. I also agree to participate in any aptitude or other testing the District believes will assist in hiring or placement decisions. 4. CRIMINAL RECORDS CHECK: I authorize for this employer to secure criminal conviction history and any record of referrals to first offender programs from the appropriate law enforcement agency, should the Board determine it is necessary to do so.Applicant Signature* First Last Date MM DD YYYY ResumeAccepted file types: jpg, gif, pdf, doc, docx.Letter of InterestAccepted file types: pdf, gif, png, doc, docx.*Please state position title and closing date.CommentsThis field is for validation purposes and should be left unchanged.