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Application for Teacher
We believe that the most important component for the success of our school is a dedicated and excellent faculty with a testimony beyond reproach.
Date: ______________________Position:____________________________________
A) PERSONAL INFORMATION
Date of Birth:___________________________
Name: ___________________________________________SSN:_________________________
Address:_________________________________________
__________________________________________ Length at this address:___________
Previous Address:________________________________________
___________________________________________Length at this address:__________
Phone:________________________Cell:____________________Email:____________________
Church Affliliation:______________________________________Member_____yes________no
Marital Status: Married_____Single______Never Married______Engaged___________ Divorced_____Separated_______Re-Married_______Widowed_______ Spouse’s Name____________________Years Married:______________
Military Status:____________________________________________________________
B) EDUCATION: School Degree Dates GPA
High School____________________________________________________________________
College________________________________________________________________________
2485 B Lost Mountain Rd. Wirtz, Va 24184 www.smlca.org 540-719-1192
College Transcripts will be required.
List other academic pursuits (Training Programs, conferences, seminars):_______________________________________________________________________________________________________________________________________________________________________________List all Certifications/Licenses (areas, levels):______________________________________________________________________________________________________________________________________________________________________________________________________List any honors or awards from college to present:_________________________________________________________________________________________________________________________________________________________________________________________________
C) TEACHING EXPERIENCE:______________________________________________________________________________Dates School Name School Address______________________________________________________________________________Subject(s) Grade Level #Students______________________________________________________________________________Supervisor Supervisor Phone/Email______________________________________________________________________________Reason Left______________________________________________________________________________Dates School Name School Address______________________________________________________________________________Subject(s) Grade Level #Students______________________________________________________________________________Supervisor Supervisor Phone/Email______________________________________________________________________________Reason Left______________________________________________________________________________Dates School Name School Address______________________________________________________________________________Subject(s) Grade Level #Students______________________________________________________________________________Supervisor Supervisor Phone/Email______________________________________________________________________________Reason Left
2485 B Lost Mountain Rd. Wirtz, Va 24184 www.smlca.org 540-719-1192
D) WORK EXPERIENCE:______________________________________________________________________________Dates Name of Establishment Title Supervisor______________________________________________________________________________Reason Left______________________________________________________________________________Dates Name of Establishment Title Supervisor______________________________________________________________________________Reason Left______________________________________________________________________________Dates Name of Establishment Title Supervisor______________________________________________________________________________Reason LeftE) CHRISTIAN AND EDUCATIONAL PHILOSOPHY:
On a separate sheet, please answer or discuss the following in one-two paragraphs:1. Briefly describe your salvation experience.2. What is your description of a biblical worldview?3. Describe events or circumstances that confirm God’s calling for you to be a teacher.4. What intentional steps do you take to grow in Christ?5. Comment on Jesus’ statement that it would be better to have a millstone tied around
your neck and thrown into a lake than to lead a little one astray.6. Why do you want to teach at SMLCA?7. Share one moment in your teaching experience where all of your training, experience
and hard work paid off.8. List all extra-curricular activities (arts, athletics) with which you have experience
F) REFERENCE:Current Pastor:Name:__________________________________Phone:______________________________Address:____________________________________________________________________Relationship:_____________________________E-Mail:_____________________________
Non-pastoral Spiritual Reference (someone who knows you well):Name:__________________________________Phone:______________________________Address:____________________________________________________________________Relationship:____________________________E-Mail:_______________________________
Education Supervisor (most recent):Name:__________________________________Phone:______________________________Address:_____________________________________________________________________Relationship:_____________________________E-Mail:_______________________________
2485 B Lost Mountain Rd. Wirtz, Va 24184 www.smlca.org 540-719-1192
One more of your choices:Name:__________________________________Phone:________________________________Address:______________________________________________________________________Relationship:_____________________________E-Mail:________________________________
G) LEGAL QUALIFICATIONS:(If you answer “yes” to any of the below questions in this section, please attach a separate sheet indicating the nature of the suit, offense, date, court, and disposition or other appropriate explanations.)
Are you presently being investigated or under a procedure to consider your discharge for misconduct by your present employer or, if you offered a resignation, your previous employer?Yes_____No_______
Have you ever been discharged or asked to resign from a prior position?Yes_____No_______
Have you ever been denied a license?Yes____No________
Have you ever been convicted (in civil or criminal proceedings) of any offense involving improprieties regarding children?Yes_____No_______
Have you ever been convicted of any crime other than the above (omit minor traffic offenses)?Yes_____No_______Have you ever entered a court plea of guilty, or “no contest” (nolo contendere), or has any court ever deferred further proceeding without entering a finding of guilty, and placed you on probation or in a public service or education program for any crime other than a minor traffic offense?Yes_____No_______
2485 B Lost Mountain Rd. Wirtz, Va 24184 www.smlca.org 540-719-1192
Non-Discrimination Statement and Policy
Smith Mountain Lake Christian Academy is an equal opportunity employer. We will not discriminate and will take measures to ensure against discrimination in employment, recruitment, advertisements for employment, compensation, termination, upgrading, promotions, and other conditions of employment against any employee or job applicant on the basis of race, color, gender, national origin, age, creed, disability, or veteran’s status.
2485 B Lost Mountain Rd. Wirtz, Va 24184 www.smlca.org 540-719-1192
Agreement of Principals and Release of Information
____I agree with and will abide by all the principles set forth in the preceding documents, without reservation. (This is not necessarily a prerequisite for employment. Please fill in below.)
_____I agree with and will abide by all the principles set forth in the preceding documents with the exception of ______________________________________________________because___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I grant permission for SMLCA to contact all employers and references listed. I also understand a criminal background check, including a FBI fingerprint review, is required for employment. I understand that if any information provided in this application proves to be false or intentionally misleading, it could disqualify my standing as a prospective applicant and could result in terminating my employment without future remuneration. I waive any right to personally review any reference information provided on my behalf.
I understand that SMLCA does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, gender, age or disability.
____________________________________________ Date:____________________________Signature
____________________________________________Printed
Mail this completed form to: Smith Mountain Lake Christian Academy2485B Lost Mountain RoadWirtz, VA 24184
Or you may email to: [email protected]
2485 B Lost Mountain Rd. Wirtz, Va 24184 www.smlca.org 540-719-1192
SMLCA Personal Information
Employee Full Name:____________________________________________________________
Date of Birth:________________________________Preferred Name:_____________________________Home Address:______________________________________________________Phone Number:_________________________Email:____________________Church Affiliation:________________________________Member: Yes___No___Pastor Name:___________________________Phone Number:_______________
Spouse Name:_____________________________________________________________Home Address (if other than above):____________________________________Daytime Phone:___________________________Cell:______________________Employer:______________________________Email:_______________________
Emergency Information:IN CASE OF ACCIDENT OR SERIOUS ILLNESS, YOU HAVE PERMISSION TO CONTACT THE FOLLOWING:Emergency Contact:_________________________Relationship:______________Address:___________________________________________________________Phone:_____________________________Cell:____________________________Family Doctor:_________________________________Phone:_______________
Hospital:_____________________________________Phone:________________
Employee Signature_____________________________Date:________________
2485 B Lost Mountain Rd. Wirtz, Va 24184 www.smlca.org 540-719-1192