New Designs Charter School Application Form
Employee Information
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Last Name
First Name
Middle Name
Street
City
State
Zip Code
Home Phone
E-Mail Address
Date of Birth
Social Security Number
Title of the position you are applying for
EDUCATION HISTORY
Start with the most recent
Education History 1
College/University Name 
Dates Attended
Degree(s)
Majors(s)/GPA
Minor(s)
Education History 2
College/University Name
Dates Attended
Degree(s)
Majors(s)/GPA
Minor(s)
EMPLOYMENT HISTORY  1
Employment history
Name of Organization
Position
Supervisor
Phone Number
Dates Employed
Reason For Leaving
EMPLOYMENT HISTORY  2
Name of Organization
Position
Supervisor
Phone Number
Dates Employed
Reason For Leaving
CONFIDENTIAL INFORMATION: Please carefully read and answer all questions. 
Have you passed the California Basic Educational Skills (CBEST)?
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Can you provide evidence that you have the legal right to work in the U.S.?
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Have you ever been discharged, dismissed, or not re-employed for the ensuing school year,
pursuant to Education Code Section 44949, from any position because of misconduct or
unsatisfactory service? (If you answered “YES” please explain on a separate sheet of paper.)
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Have you ever had teaching or administrative credential suspended or revoked? (If you
answered “YES” please explain on a separate sheet of paper.)
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Have you ever resigned a teaching position or other employment in lieu of disciplinary action?
(If you answered “YES” please explain on a separate sheet of paper.)
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Have you ever left a teaching or administrative position without official approval of the
governing board? (If you answered “YES” please explain on a separate sheet of paper.)
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PLEASE READ CAREFULLY BEFORE SIGNING
APPLICANT'S CERTIFICATION AND AGREEMENT

I hereby certify that all of the facts and statements made in this Application for Employment are true and
complete to the best of my knowledge. Further, I understand that any misstatement, misrepresentation, or
omission of information on my part may subject me to disqualification for consideration for employment or, if
employed, my dismissal. If I am employed, false statements, omissions or misrepresentations may result in my
dismissal.
I understand that my placement on the salary schedule at the School shall be based upon the certifications,
credentials, and experience I confirm for the School at the time of hire. Unless I provide further evidence to the
School affecting my placement on the salary schedule within thirty (30) days of my hire, my placement shall not
be subject to change until the following year and I shall not be eligible for any retroactive pay in connection with
my initial placement.
I hereby authorize the School to conduct an investigation of any of the information set forth in this Application
for Employment.
I further understand that my employment will be contingent upon, as a condition of employment, my successful
fulfillment of requirements that include but are not limited to: a) fingerprinting for a background clearance for
employment in a public school; b) clearance through a background investigation for employment in a public
school, including reference checks; c) submission of proof that I am free of tuberculosis risk factors (or active
tuberculosis, if risk factors were identified); d) submission of documentation to verify my identity and my right
to work in the United States; and e) as required by the position, submission to and passing of a drug and/or
alcohol screening to obtain and retain employment.
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