___________________Date of Application
First Name Middle Name Last Name Social Security No.
- -
Address (street number and name) City State
County Zip Cell Telephone Home Phone
Date of Birth
__________/____________/_________________ month day year
Driver’s License Number Issuing State Are you willing to drive the school van?
Email Address:
Permanent full-time
Permanent part-time Substitute/Temporary Position Applied ForLead Teacher
(must have NCECC minimum) Teacher Floater Chef
Check age group
preference Infants
Toddlers
Two Year Olds Three Year Olds
Four Year Olds TK
Kindergarten Afterschool Schedule List Preferred Hours?
Can you open 7:00am? __________ Can you close 6:00pm? __________
Possible scheduling conflicts?
Education
highest level completed: College: Graduate School:
Schools Name and Location Dates Attended Course of Study Degree or
Diploma Date Awarded
High School to to to College or University to to to Graduate or Professional to Special training programs or coursework you have completed in the last five years (list):
Current professional status: Certification Level
Membership in professional, honorary or technical societies (list):
Date: _________/_________/____________
Work History
May Providence Preparatory School ask your present employer about your character, qualifications, and employment records? A “No” will not Affect you consideration for employment opportunities.
Yes No
(Start with the present position and go back 10 years. You may include volunteer work. Account for periods of unemployment in separate blocks in order.)
1
Most
Recent
Employer
Name of Employer with complete mailing address Starting Salary/Earnings $ per
Present Salary/Earnings $ per
Dates of Employment (Month & Year) TO
Average hours per week Telephone Number
Exact Position Title Kind of Business
Name and title of supervisor Description of duties, responsibilities, and accomplishments
Reason for leaving
2
Name of Employer with complete mailing address Starting Salary/Earnings $ perPresent Salary/Earnings $ per Dates of Employment (Month & Year)
TO
Average hours per week Telephone Number
Exact Position Title Kind of Business
Name and title of supervisor Description of duties, responsibilities, and accomplishments
Reason for leaving
3
Name of Employer with complete mailing address Starting Salary/Earnings $ perPresent Salary/Earnings $ per Dates of Employment (Month & Year)
TO
Average hours per week Telephone Number
Exact Position Title Kind of Business
Name and title of supervisor Description of duties, responsibilities, and accomplishments
Reason for leaving
4
Name of Employer with complete mailing address Starting Salary/Earnings $ perPresent Salary/Earnings $ per Dates of Employment (Month & Year)
TO
Average hours per week Telephone Number
Exact Position Title Kind of Business
Name and title of supervisor Description of duties, responsibilities, and accomplishments
Name(First, MI, Last)
Date: _________/_________/____________
References
Give a minimum of three references, not relatives or former employers, who know you know you professional, through community involvement and personally.
Name Telephone Occupation
Please Answer the Following Questions:
“Criminal history” includes county, state, and federal convictions or pending indictments of any of the following crimes as set forth in the Following Articles of Chapter 14 of the North Carolina General Statutes (“NCGS”) : Article 6, Homicide; Article 7A, Rape and Kindred Offenses; Article 8, Assaults; Article 10, Kidnapping and Abduction; Article 13, Malicious Injury or Damage by Use of Explosive or Incendiary Device or Material; Article 26, Offenses Against Public Morality and Decency; Article 27, Prostitution; Article 39, Protection of Minors; Article 40,
Protection of the Family; and Article 59, Public Intoxication; violation of the North Carolina Controlled Substances Act, Article 5 of Chapter 90 of the NCGS, and alcohol-related offenses such as sale to underage persons in violation of NCGS 18B-302 or driving while impaired in violation of NCGS 20-138.1 through NCGS 20-138.5; or similar crimes under federal law or under the laws of other states.
Have you ever been convicted of breaking a law other than a minor traffic violation?
YES NO If yes, give the date and explain fully on an additional piece of paper if more space is needed Have you ever had a Department of Social Services (DSS) substantiation?
YES NO If yes, list county/State and give the date and explain fully on an additional piece of paper if more space is needed
(The offense(s) and how recently you were convicted will be evaluated in relation to the job for which you are applying.)
Are you at least 18 years of age and legally eligible for work in the United States? Yes No Will you work after hours and weekend special events when necessary?
Yes No
Are you on layoff and subject to recall? Yes No
Are you currently bound by a noncompetition or trade secret agreement? Yes No
Have you been discharged or asked to resign from a job? Yes No
If yes, please explain
Do you have physical limitations that limit or restrict you from lifting or caring children? Yes No If yes, please explain
Is childcare desired? Yes No
If yes, list ages of children
AFFIDAVIT OF APPLICANT:
I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In
the event confirmation is needed in connection with my work, I authorize educational institutions, associations,
registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I
authorize investigations of all statements made in this application and understand that false information of
documentation, or a failure to disclose relevant information may be grounds for rejection of my application,
disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on
unemployment shall be mandatory if fraudulent disclosures are given to meet position qualifications. I understand
that acceptance of this Application of Employment by Providence Preparatory School (“PPS”) shall not be
construed by me as an offer or invitation to work for, be hired by or become employed by PPS.
Pre-Interview Questions
1. Why are you interested in working for Providence Preparatory School?
2. If you were choosing a school for your child or a friend’s child, what would you look for?
3. What is the most important quality you have to offer children?
4. Describe a situation where you planned an activity for children that did not work out?
5. What is your preferred curriculum and are you willing to learn how to implement new/multiple curriculums?
6. Are you interested in training others on specific skills you believe you have mastered? Please list topics.
Name(First, MI, Last)
Date: _________/_________/____________