EMPLOYMENT APPLICATION. Position(s) for which you are applying: Date: Personal Information. Legal Name: Last First Middle Maiden.

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1 Effort Christian School and Preschool A ministry of Effort Baptist Church 7829 Thomas Jefferson Parkway Palmyra, Virginia Your interest in Effort Christian School and Preschool is appreciated. We invite you to fill out this application and return it to our school office. We realize that the key to a successful Christian School is its staff. We are seeking applicants who are professionally qualified, and by the pattern of their lives, are Christian role models. We look forward to receiving your application. Thank you for your interest in the ministry of our school, and it is our prayer that God will fulfill His perfect will in the lives of all applicants.

2 Effort Christian School and Preschool A ministry of Effort Baptist Church 7829 Thomas Jefferson Parkway Palmyra, Virginia Office Use: Date Received: Ref. checked: Background check received: Interview Date: Payroll/tax completed: Other: EMPLOYMENT APPLICATION Position(s) for which you are applying: Date: Personal Information Legal Name: Last First Middle Maiden Address: Street City State Zip Code Home Telephone: Cell Phone: Address: h Education and Training High School City/State Year Graduated Type of Degree Dates of Attendance (From To) Trade School College/University College/University Other

3 Indicate any special qualifications or other relevant skills: Professional Certificate or License Virginia License Type: Endorsement(s): Expiration Date: Out of State Certification or License State(s) Type: Endorsement(s): Expiration Date: Employment History Please list all employment beginning with the most recent. Use additional sheets if needed. Employer s Name and Address: Reason For Leaving: Employer s Name and Address: Reason For Leaving:

4 Employer s Name and Address: Reason For Leaving: Employer s Name and Address: Reason For Leaving: General Information If you answer yes to any of the questions 2 through 8, you must explain in the Additional Remarks section. 1. Are you eligible for U.S. employment? YES NO 2. Have you ever been discharged or requested to resign from a former position? YES NO 3. Have you ever been convicted of a violation of law other than a minor traffic violation? YES NO 4. Have you ever been convicted of a felony? YES NO 5. Have you ever been convicted of an offense involving sexual molestation, physical or sexual abuse or rape of any kind? YES NO 6. Are any criminal charges or proceedings pending against you? YES NO 7. Do you have relatives working with Effort Christian School and Preschool or Effort Baptist Church? YES NO If yes, please indicate name: position: 8. Are you able to perform the duties of the job for which you are applying? YES NO Additional Remarks (Use additional sheets if needed.):

5 Philosophy of Education in a Christian Setting What do you consider to be the distinctive characteristics of the Christian school? What is your philosophy/approach to discipline in the classroom? What do you hope to accomplish as an educator in a Christian school setting? Why do you want to teach at Effort Christian School or Effort Christian Preschool? Though you need not be a member of Effort Baptist Church to serve in our school, we certainly want to be sure our employees influence our students with a positive Christian witness. Do you consider yourself to be a Christian? YES NO What is your definition of a Christian? Briefly state your personal relationship with God:

6 References Please provide three professional references of persons who possess direct knowledge of your qualifications for the position for which you are applying - for example - former supervisors, principals, professors, etc. Name and Title Address Phone Number Relationship Please read carefully before signing. My signature below verifies the facts set forth in this entire application are true and complete. I understand that if employed, falsified or misrepresentative statements or omissions on this application or any oral or written supplement to it shall be considered sufficient cause for dismissal. My signature below authorized Effort Baptist Church to conduct a background investigation and authorizes release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal and professional references, and other appropriate sources. I waive my right of access to any such information, and without limitation release Effort Baptist Church and the reference source from any liability in connection with it s release or use. Signature : Date: