Arizona's private dyslexia school The Jones-Gordon School Paradise Valley, Arizona Employment Application "*" indicates required fields Step 1 of 5 20% Application for EmploymentFirst Name* Middle Name Last Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Available Start Date* MM slash DD slash YYYY What type of employment are you interested in?*(Check all that apply) Full Time Part Time Occasional ("As-Needed") Temporary/Seasonal (< 6 months) Independent Contractor Willing to work (if needed):(Check all that apply) outside of regular business hours weekends during school breaks What days and/or hours are you unable or unwilling to work? Are you a former JGS/OTT employee or independent contractor?* Yes No If yes, provide dates: Are you legally eligible for employment in the U.S. without sponsorship?*(Proof of identity & eligibility required upon employment.) Yes No If you were referred to us, please provide the following:Individual’s name: Relationship to you: If not referred to us, how did you learn of this employment opportunity? Areas of Interest(Check all that apply)*(Check all that apply) Administration/Management Clerical Faculty Support Staff Tutor Specific position(s) desired: Subjects you are qualified to teach: Activities you are qualified to lead: Educational BackgroundName and Location of School/College/University Course of Study(Provide Major/Minor) GPA Degree/Credits Earned(Do not provide year) Graduated? Yes No Name and Location of School/College/University Course of Study(Provide Major/Minor) GPA Degree/Credits Earned(Do not provide year) Graduated? Yes No Name and Location of School/College/University Course of Study(Provide Major/Minor) GPA Degree/Credits Earned(Do not provide year) Graduated? Yes No Name and Location of School/College/University Course of Study(Provide Major/Minor) GPA Degree/Credits Earned(Do not provide year) Graduated? Yes No Certifications, Endorsements, and LicensesVerification will be completed based on the information provided.Certificates, Endorsements or Licenses (Explain Type) State of Issue Issued/Award Date Expiration Date Certificates, Endorsements or Licenses (Explain Type) Issued/Award Date State of Issue Expiration Date Certificates, Endorsements or Licenses (Explain Type) State of Issue Issued/Award Date Expiration Date Certificates, Endorsements or Licenses (Explain Type) State of Issue Issued/Award Date Expiration Date Have you ever been denied a teaching certificate or license, or had your teaching certificate or license suspended or revoked? Yes No Not Applicable If yes: Denied Suspended Revoked Which State(s): Do you have a current Fingerprint Clearance Card?*(IVP required) Yes No In Process Card Number: Issue Date: Expires: List any additional relevant certifications, specialized trainings, honors/awards(Please also describe any specific academic programs with which you have experience—i.e. specialized math, phonics, reading or writing programs, if applying for a teaching position) Employment HistoryProvide accurate and complete history starting with current/most recent (please DO NOT put “see resume”).School/Employer: Location PhoneDates of Employment From: MM slash DD slash YYYY Dates of Employment To: MM slash DD slash YYYY Beginning Title/Position: Salary Start: per(hour/day/year) Ending Title/Position: Salary End: per(hour/day/year) Description of Duties:(If teaching position, list grades and subjects taught)Reason for Leaving: Name and Title of Supervisor: May we contact this employer? Yes No If no, why? School/Employer: Location PhoneDates of Employment From: MM slash DD slash YYYY Dates of Employment To: MM slash DD slash YYYY Beginning Title/Position: Salary Start: per(hour/day/year) Ending Title/Position: Salary End: per(hour/day/year) Description of Duties:(If teaching position, list grades and subjects taught)Reason for Leaving: Name and Title of Supervisor: May we contact this employer? Yes No If no, why? School/Employer: Location PhoneDates of Employment From: MM slash DD slash YYYY Dates of Employment To: MM slash DD slash YYYY Beginning Title/Position: Salary Start: per Ending Title/Position: Salary End: per Description of Duties:(If teaching position, list grades and subjects taught)Reason for Leaving: Name and Title of Supervisor: May we contact this employer? Yes No If no, why? School/Employer: Location PhoneDates of Employment From: MM slash DD slash YYYY Dates of Employment To: MM slash DD slash YYYY Beginning Title/Position: Salary Start: per(hour/day/year) Ending Title/Position: Salary End: per(hour/day/year) Description of Duties:(If teaching position, list grades and subjects taught)Reason for Leaving: Name and Title of Supervisor: May we contact this employer? Yes No If no, why? Have you ever been asked to resign or involuntarily been terminated from a job?* Yes No If yes, please explain:Have you encountered gaps in your employment history that are NOT due personal illness, injury or disability?* Yes No If yes, please explain, but please do not list information pertaining to personal illness, injury or disability:Driving RecordComplete for driving positions only. Please be aware that teachers may be required to drive for school purposes.Do you possess a valid, unexpired driver’s license:* Yes No State of Issue: Do you have access to a vehicle to use for business purposes, if applicable to the position?* Yes No Is there any reason that you would not be approved as a driver when a motor vehicle record report is run?* Yes No Is yes, explain:Criminal RecordHave you ever been convicted of a crime(s), including misdemeanors?* Yes No If yes, explain in full:*NOTE: The conviction of a crime does not necessarily exclude a candidate from consideration of employment.Professional ReferencesList three references who have knowledge of your professional/teaching experience. (Only list people you want contacted. Do not list relatives or HES/JGS employees. All information is required.)Name Phone/Email Occupation/Business Relationship Length Known Name Phone/Email Occupation/Business Relationship Length Known Name Phone/Email Occupation/Business Relationship Length Known Please submit copies of each of the following along with your application (as applicable):Current Resume, Letters of Recommendation, Teaching Certificate, Fingerprint Clearance Card Drop files here or Select files Max. file size: 100 MB. Applicant's Authorization and AgreementI AFFIRM THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUTHFUL AND ACCURATE, TO THE BEST OF MY ABILITY. IN SUBMITTING THIS APPLICATION, I UNDERSTAND THAT ANY EMPLOYMENT IS CONDITIONAL ON A BACKGROUND CHECK AND THAT AN INVESTIGATIVE CONSUMER REPORT, IN ACCORDANCE WITH APPLICABLE LAW, MAY BE MADE WHEREBY INFORMATION MAY BE OBTAINED REGARDING MY CHARACTER, PREVIOUS EMPLOYMENT, EDUCATIONAL BACKGROUND AND CRIMINAL HISTORY. I AUTHORIZE ANYONE POSSESSING THIS INFORMATION TO FURNISH IT TO JONES-GORDON FOUNDATION / THE JONES-GORDON SCHOOL / ON-TRACK TUTORING (JGF), UPON REQUEST AND I RELEASE JGF FROM ALL LIABILITY AND DAMAGES WHATSOEVER IN FURNISHING, OBTAINING, OR USING SAID INFORMATION. I UNDERSTAND THAT UPON WRITTEN REQUEST WITHIN A REASONABLE PERIOD OF TIME, I CAN OBTAIN FROM JGF WRITTEN DISCLOSURE OF THE NATURE AND SCOPE OF ANY SUCH REPORT. I UNDERSTAND AND AGREE THAT NOTHING IN THIS APPLICATION, OR CONVEYED VERBALLY, IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT. I FURTHER UNDERSTAND AND AGREE THAT IF I AM HIRED, MY EMPLOYMENT WILL BE “AT-WILL” AND MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE, AT THE OPTION OF EITHER JGF OR MYSELF. I UNDERSTAND THAT SUBMITTING AN APPLICATION DOES NOT GUARANTEE EMPLOYMENT OF ANY KIND.*I AFFIRM THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUTHFUL AND ACCURATE, TO THE BEST OF MY ABILITY. IN SUBMITTING THIS APPLICATION, I UNDERSTAND THAT ANY EMPLOYMENT IS CONDITIONAL ON A BACKGROUND CHECK AND THAT AN INVESTIGATIVE CONSUMER REPORT, IN ACCORDANCE WITH APPLICABLE LAW, MAY BE MADE WHEREBY INFORMATION MAY BE OBTAINED REGARDING MY CHARACTER, PREVIOUS EMPLOYMENT, EDUCATIONAL BACKGROUND AND CRIMINAL HISTORY. I AUTHORIZE ANYONE POSSESSING THIS INFORMATION TO FURNISH IT TO JONES-GORDON FOUNDATION / THE JONES-GORDON SCHOOL / ON-TRACK TUTORING (JGF), UPON REQUEST AND I RELEASE JGF FROM ALL LIABILITY AND DAMAGES WHATSOEVER IN FURNISHING, OBTAINING, OR USING SAID INFORMATION. I UNDERSTAND THAT UPON WRITTEN REQUEST WITHIN A REASONABLE PERIOD OF TIME, I CAN OBTAIN FROM JGF WRITTEN DISCLOSURE OF THE NATURE AND SCOPE OF ANY SUCH REPORT. I UNDERSTAND AND AGREE THAT NOTHING IN THIS APPLICATION, OR CONVEYED VERBALLY, IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT. I FURTHER UNDERSTAND AND AGREE THAT IF I AM HIRED, MY EMPLOYMENT WILL BE “AT-WILL” AND MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE, AT THE OPTION OF EITHER JGF OR MYSELF. I UNDERSTAND THAT SUBMITTING AN APPLICATION DOES NOT GUARANTEE EMPLOYMENT OF ANY KIND. I understand and agree.Digital Signature of Applicant:* Date Signed:* MM slash DD slash YYYY Return Home
