Employment Application

Application for Employment
First Name
Middle Name
Last Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Available Start Date
MM slash DD slash YYYY
Are you age 21 or over?
- Yes
- No
What type of employment are you interested in?
- Full Time Regular
- Part Time Regular
- Occasional ("As-Needed")
- Temporary (< 6 months)
(Check all that apply)
Willing to work:
- additional hours, if needed
- weekends, if needed
- during school breaks, if needed (for academy positions)
(Check all that apply)
What days and/or hours are you unable and unwilling to work?
Are you a former HES/JGS employee or independent contractor?
- Yes
- No
If yes, provide dates:
Are you legally eligible for employment in the U.S. without sponsorship?
- Yes
- No
(Proof of identity & eligibility required upon employment.)
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)
- Administration/Management
- Lower School
- Middle School
- High School
- Support Staff
(Check all that apply)
Specific position(s) desired:
Subjects you are credentialed or otherwise qualified to teach:
Activities you are qualified to lead:
Educational Background
Name and Location of School/College/University
GPA
Course of Study

(Provide Major/Minor)
Graduated?
- Yes
- No
Degree/Credits Earned

(Do not provide year)
Name and Location of School/College/University
GPA
Course of Study

(Provide Major/Minor)
Graduated?
- Yes
- No
Degree/Credits Earned

(Do not provide year)
Name and Location of School/College/University
GPA
Course of Study

(Provide Major/Minor)
Graduated?
- Yes
- No
Degree/Credits Earned

(Do not provide year)
Name and Location of School/College/University
GPA
Course of Study

(Provide Major/Minor)
Graduated?
- Yes
- No
Degree/Credits Earned

(Do not provide year)
Certifications, Endorsements, and Licenses
Verification 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)
State of Issue
Issued/Award Date
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):
Fingerprint Clearance Card
- Yes
- No
- In Process
(required IVP, if issued after 12/31/2007)
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 History
Provide accurate and complete history starting with current/most recent (please DO NOT put “see resume”).
One
School/Employer:
Location
Phone
Dates of Employment From:
MM slash DD slash YYYY
Dates of Employment To:
MM slash DD slash YYYY
Salary Start:
per
Salary End:
per
Beginning Title/Position:
Ending Title/Position:
Name and Title of Supervisor:
Description of Duties:
(If teaching position, list grades and subjects taught)
Reason for Leaving:
May we contact this employer?
- Yes
- No
If no, why?
Two
School/Employer:
Location
Phone
Dates of Employment From:
MM slash DD slash YYYY
Dates of Employment To:
MM slash DD slash YYYY
Salary Start:
per
Salary End:
per
Beginning Title/Position:
Ending Title/Position:
Name and Title of Supervisor:
Description of Duties:
(If teaching position, list grades and subjects taught)
Reason for Leaving:
May we contact this employer?
- Yes
- No
If no, why?
Three
School/Employer:
Location
Phone
Dates of Employment From:
MM slash DD slash YYYY
Dates of Employment To:
MM slash DD slash YYYY
Salary Start:
per
Salary End:
per
Beginning Title/Position:
Ending Title/Position:
Name and Title of Supervisor:
Description of Duties:
(If teaching position, list grades and subjects taught)
Reason for Leaving:
May we contact this employer?
- Yes
- No
If no, why?
Four
School/Employer:
Location
Phone
Dates of Employment From:
MM slash DD slash YYYY
Dates of Employment To:
MM slash DD slash YYYY
Salary Start:
per
Salary End:
per
Beginning Title/Position:
Ending Title/Position:
Name and Title of Supervisor:
Description of Duties:
(If teaching position, list grades and subjects taught)
Reason for Leaving:
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 Record
Complete 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 Record
Have 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 References
List 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
Educational Philosophy
Describe your ideal classroom. What does it look like, how does it function, what systems are in place?
Describe your approach to differentiating instruction when students of various abilities are working within the same grouping.
What subjects/content areas and age groups do you believe you are most effective at teaching? Which do you most enjoy?
What type of student poses the greatest challenge for you? What would/do you do to help those students be successful?
Please detail your experience working with students who have learning and/or attention disorders.
Please submit copies of each of the following along with your application (as applicable):
- Current Résumé
- Letters of recommendation
- Teaching Certificate
- Fingerprint Clearance Card
Applicant's Authorization and Agreement
I AUTHORIZE THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUTHFUL AND ACCURATE, TO THE BEST OF MY ABILITY.
Please initial
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 ON-TRACK ACADEMY/ON-TRACK TUTORING & FAMILY SUPPORT SERVICES, INC. (OTTA), UPON REQUEST AND I RELEASE OTTA 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 OTTA WRITTEN DISCLOSURE OF THE NATURE AND SCOPE OF ANY SUCH REPORT.
Please initial
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 OTTA OR MYSELF.
Please initial
Submitting an application does not guarantee employment of any kind.
Digital Signature of Applicant:
Date Signed:
MM slash DD slash YYYY

Employment Application

Application for Employment

Areas of Interest

Educational Background

Certifications, Endorsements, and Licenses

Employment History

One

Two

Three

Four

Driving Record

Criminal Record

Professional References

Educational Philosophy

Applicant's Authorization and Agreement