Today's Date Your Name (First, Last) (required) Your Email (required) Address Street Address Address Line 2 City State Zip Code Phone Number (Best to be reached at) Date you are available to start? Are you a US Citizen? YesNo CERTIFICATION Certified in the State of Arizona? Type / State of Issue / Expiration Date Degree / Date Granted Major Endorsement Major Endorsement Approved Areas EDUCATION College / Location Degree / Date Granted Major Field / Minor Field EMPLOYMENT EXPERIENCE Employer #1 Dates Worked | From: To: Address / Telephone Number Describe Your Duties Reason For Leaving Employer #2 Dates Worked | From: To: Address / Telephone Number Describe Your Duties Reason For Leaving Employer #3 Dates Worked | From: To: Address / Telephone Number Describe Your Duties Reason For Leaving REFERENCES Reference #1 Name Position Phone # Reference #2 Name Position Phone # Reference #3 Name Position Phone # NARRATIVE STATEMENT Upload Statement if Available 1. What would be the most significant contribution you will make to our school? 2. What are you ideas about student discipline and behavior? 3. What instructional strategies and teacher behaviors do you believe will make the most significant difference in student learning in an alternative school for at-risk students? 4. How will you actively involve reluctant students and parents in developing an understanding of the importance of education? ACKNOWLEDGEMENTS I acknowledge that inquires may be made to obtain job related information from my previous and present employers, whether or not they are listed on the attached application, and that similar inquires may be directed to the persons listed as professional references, as well as to other individuals who know me. I further acknowledge that inquires may, at the discretion of prospective employers, make inquires of law enforcement agencies, the Department of Motor Vehicles, and education institutions, and may initiate investigations by private persons for the purpose of verifying information supplied by me or to obtain additional information. I authorize such inquiry and investigation and the giving and receiving of any information requested by the school as part of such inquiry and investigation. I further acknowledge that application for Arizona certification requires a complete background and fingerprint check executed prior to my employment. I understand that I will be responsible for the payment of all fees associated with this background/fingerprint check. I further acknowledge that, upon employment, I will be required to provide proof of immunity to infectious diseases by providing the following: MEASLES: Anyone born after January 1, 1957 must show proof of immunity by one of the following: (1) medical records showing person received vaccine after 15 months of age and the date of immunization. Vaccine must have been the live virus vaccine and give after 1968. (2) Blood test confirming immunity. RUBELLA: Anyone born after January 1, 1942 must show proof of immunity by one of the following: (1) Medical records showing person received the vaccine after 15 months of age and the date of immunization. Vaccine must have been the live virus vaccine and given after 1968. (2) Blood test confirming immunity. I further acknowledge that the Academy of Building Industries may release any and all application materials to schools with which they have contracts for the recruitment of certificated staff members and give my full and unreserved permission for the release of said materials. I also release Academy of Building Industries and any of its agents from liability for any claims arising from such release of information, background inquiries, and investigations. I affirm that all information provided by me on this application is true, and I understand that if any part of the information is false or misrepresented (including omission of information called for), my application may not be considered, or if I am employed by a school, will be sufficient grounds for discharge. A photocopy of this release shall be as effective as the original. By typing your full name below, you attest that statements made in this application are true and unaltered. You also agree to the terms laid out in the above acknowledgement. Date Questions?