Teacher Application Form

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1 Teacher Application Form 210 Commerce Lake Drive Saint Augustine, FL Phone: (904) Fax: (904) Your interest in Roots and Wings Learning Center is greatly appreciated. Our teachers and their leadership are vital to helping us carry out our mission. We seek teachers who understand and love children, who are gifted to teach and who exemplify our vision in and out of the classroom. We look forward to receiving your completed application soon. If it appears that you may be qualified for one of our openings, a personal interview will be arranged. Today s Date Position Applying For Desired Pay What age would you prefer to work with? Tell us about yourself Last Name First Name MI Current Address City Phone Number State Zip Social Security Number Teaching Credentials: Do you have a state-issued teaching certificate? [] yes [] no If so, from what state? Is it currently valid? Expiration date? List any other teaching credentials (Order of Preference)

2 Tell Us About Your Experience List all of your Teaching and or work Experience: What Degrees do you hold? [] AA Tell Us About Your Professional Training [] BA Major Minor [] Master s Major [] Doctoral Field Please list the institutions from which you have attended and received degrees: List any Early Childhood Courses that you have completed: Have you completed the required 40 hours state mandated classes? [] yes [] no

3 References Please give us the names of individuals who can attest to your character and teaching abilities. Include a principal, if you have prior teaching experience, or a supervisor for a previous non-teaching job. Be sure that at least one of these was a direct supervisor overseeing your work. Name Position Phone Number Tell Us About Your Personal Experience Please describe any NON-TEACHING experiences or training you have had that you believe would enhance your ability to teach at Roots and Wings Learning Center. Where do you hope to be in FIVE YEARS: Declaration of Moral Integrity As an applicant for employment or for a volunteer position with unsupervised access to children at Roots and Wings Learning Center, I (please print your name) Recognize, understand, and agree to live by the moral standards of the Center. I further declare that with regard to my personal moral character and conduct as of this date, I am not, nor have been in the past engaged in inappropriate conduct, nor do I have inclinations toward such conduct. Applicant s Signature Date

4 Authorization to Release Reference Information I have filled out an application for a position as a with Roots and Wings Learning Center. I have authorized the center to thoroughly interview the primary references which I have listed, any secondary references mentioned through interviews with my primary references, or other individuals, who know me and have knowledge regarding my testimony and work record. I also authorize the Center to thoroughly investigate my work records and evaluations, my educational preparation, and all other matters related to my suitability for employment. I authorize references and my former employers to disclose to the Center any and all employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure. In addition, I hereby release Roots and Wings Learning Center, my former employers, references, and all other parties from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I waive the right to ever personally view any references given to Roots and Wings Learning Center. I agree that a photocopy or facsimile copy of this document and any signature shall be considered for all purposes as the original signed release on file. Applicant s Name (print) Applicant s Signature

5 Applicant s Certification and Agreement I understand that Roots and Wings Learning Center does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, gender, age or disability. I hereby certify that the facts set forth in this initial application are true and complete to the best of my knowledge. I understand that discovery of falsification of any statement or a significant omission of fact may prevent me from being hired, or if hired, may subject me to immediate dismissal regardless of the time elapsed before discovery. If I am released under these circumstances, I further understand that I will be paid and receive benefits only through the day of release provided that I have met the required probationary periods as stated in the Employee Handbook. I authorize Roots and Wings Learning Center to thoroughly interview the primary references which I have listed, any secondary references mentioned through interviews with primary references, or other individuals, who know me and have knowledge regarding my testimony and work record. I also authorize the school to thoroughly investigate my work records and evaluations, my educational preparation, and other matters related to my suitability for the job. I authorize references and former employers to disclose to the center any and all employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure. In addition, I hereby release the center, my former employers, references, and all other parties from any and all claims, demands, or liabilities arising out of or in any way related to such investigation and disclosure. I waive the right to ever personally view any reference given to the school. Since I will be working with children, I understand that I must submit to a fingerprint check by the FBI and possibly other federal and state authorities, I agree to fully cooperate in providing and recording as many sets of fingerprints as are necessary for such an investigation. I authorize the center to conduct criminal records check. I understand and agree that any offer of employment that I may receive from the center is conditioned upon the receipt of background information, including criminal background information. The center may refuse employment or terminate conditional employment if the center deems any background information unfavorable or to reflect adversely on the center or on me, as a role model. I understand that this is only an application for employment and that no employment contract is being offered at this time. I certify that I have carefully read and do understand the above statements. Signature of Applicant Date

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