Columbia Academy Employment Application
Thank you for your interest in being a part of carrying out the mission of Columbia Academy.
School bylaws, which were established when Columbia Academy opened in 1979, requires faculty and staff (other than food services and building and grounds) to be an active member of a Church of Christ congregation.
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Applicant Name: *
Maiden Name (if applicable):
Address, City, State, Zip: *
Telephone number: *
Are you legally eligible for employment in the United States: *
Position(s) applied for: *
Will you accept employment that is: *
Date you are available to start work: *
Salary or wages desired: *
Have you worked for CA before? *
If yes, when?
Of which church of Christ congregation are you an active member?  Please include city/state. *
Do you drink alcohol? *
Do you use tobacco? *
Please indicate any special qualities and/or skills:
EDUCATION
Did you graduate from high school? *
Name and location of high school *
Did you graduate from college *
Name and location of college/university
College course of study
What is the highest level of education you have completed? *
Have you ever been convicted of a crime (other than a minor traffic violation)? *
If yes, list convictions (a conviction does not necessarily disqualify an applicant for the position):
Are you employed at the present time? *
If hired, will you work overtime if required? *
WORK EXPERIENCE
Employer 1 *
City/State: *
Employer phone number: *
Job title and duties: *
Are you employed at this time? If not, reason for leaving. *
Dates Employed:  Month/Year began - Month/Year ended *
Supervisor's name: *
Starting and ending salary/wages: *
Employer 2 *
City/State: *
Employer phone number: *
Job title and duties: *
Are you employed at this time? If not, reason for leaving. *
Dates Employed:  Month/Year began - Month/Year ended *
Supervisor's name: *
Starting and ending salary/wages: *
Employer 3
City/State:
Employer phone number:
Job title and duties:
Are you employed at this time? If not, reason for leaving.
Dates Employed:  Month/Year began - Month/Year ended
Supervisor's name:
Starting and ending salary/wages:
Please explain any gaps in your employment history:
Have you ever been terminated, asked to resign, or had an employment contract not renewed? *
If yes, please explain:
MILITARY SERVICE
Branch of Service
Dates of Service:  Month/Year began - Month/Year ended
Rank & Duties:
Honorable Discharge?
REFERENCES
Please include at least one educational reference and one Elder or Minister
Type of Reference *
Name: *
Organization: *
Relationship: *
City/State: *
Years Known: *
Phone: *
Email: *
Type of Reference *
Name: *
Organization: *
Relationship: *
City/State: *
Years Known: *
Phone: *
Email: *
Type of Reference *
Name: *
Organization: *
Relationship: *
City/State: *
Years Known: *
Phone: *
Email: *
ADDITIONAL INFORMATION
TN Teacher Certification Number
Date Expires:
MM
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DD
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YYYY
Certified for Grades:
Areas of Certification:
Teacher Certification from Other States? If so, please specify:
Have you had any teacher certificate suspended or revoked:
If yes, why?
Other areas with 12 or more college credit hours?
Subjects you prefer to teach:
Grades you prefer:
Sports or Activities you could coach or sponsor?
Is there any other information you would like to share?  If so, please use this space to do so.
The information submitted is true and complete to the best of my knowledge.  Should I be employed by the School, any misrepresentation or false statement contained herein may be considered cause for possible dismissal.  The School, in compliance with the provisions of the Fair Credit Reporting Act of Sept. 1997, may contact directly or employ the services of investigative agencies to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history, or credit standing.  I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the School.

I understand this application does not constitute an employment contract of any kind.  Should I be employed by the School, I may resign such employment at any time at my discretion with or without notice, unless a separate school written contract is executed and the School may terminate my employment at any time at their discretion, with or without cause and with or without prior notice, unless a separate school written contract is executed.

Electronic Signature
The electronic signature and related fields below are treated by Columbia Academy like a physical handwritten signature on a paper form.
Check for Electronic Signature *
Required
Name: *
Date: *
MM
/
DD
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YYYY
Email address: *
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