Staff employment application

Personal Information

Position Applying For: Please enter valid data.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Email REQUIRED Please fill out this field. Please enter an email address.
Daytime Phone: Please enter valid data.
Evening/Cell Phone: Please enter valid data.
Please list any other former name(s) or alias you may be using or have used in the past: Please enter valid data.
Referred by: Please enter valid data.

Skills & Education

What skills do you possess to qualify you for this position?

Education/Training #1

Institution Name: Please enter valid data.
Location: Please enter valid data.
Major/Subject: Please enter valid data.
Years Completed: Please enter valid data.
Graduation Degree: Please enter valid data.

Education/Training #2

Institution Name: Please enter valid data.
Location: Please enter valid data.
Major/Subject: Please enter valid data.
Years Completed: Please enter valid data.
Graduation Degree: Please enter valid data.

Education/Training #3

Institution Name: Please enter valid data.
Location: Please enter valid data.
Major/Subject: Please enter valid data.
Years Completed: Please enter valid data.
Graduation Degree: Please enter valid data.

Education/Training #4

Institution Name: Please enter valid data.
Location: Please enter valid data.
Major/Subject: Please enter valid data.
Years Completed: Please enter valid data.
Graduation Degree: Please enter valid data.

Any state certifications held: Please enter valid data.

Describe any specialized training you have received which would assist you in this position: Please enter valid data.

Specific Job Experience

Previous Employer #1 Please enter valid data.
Address & Phone Please enter valid data.
Position Title/Duties: Please enter valid data.
Supervisor: Please enter valid data.
Salary: Please enter valid data.
Dates Employed: Please enter valid data.
Reason for Leaving: Please enter valid data.

Specific Job Experience:

Previous Employer #2 Please enter valid data.
Address & Phone Please enter valid data.
Position Title/Duties: Please enter valid data.
Supervisor: Please enter valid data.
Salary: Please enter valid data.
Dates Employed: Please enter valid data.
Reason for Leaving: Please enter valid data.

Other Work Experience (List details as above):

Have you worked at any location within the Bismarck Diocese before? Yes No

If yes, when? Please enter valid data.

Reference #1

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Business/Address: Please enter valid data.
Title/Position: Please enter valid data.
Phone Number: Please enter valid data.
Dates Known: Please enter valid data.

Reference #2

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Business/Address: Please enter valid data.
Title/Position: Please enter valid data.
Phone Number: Please enter valid data.
Dates Known: Please enter valid data.

Reference #3

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Business/Address: Please enter valid data.
Title/Position: Please enter valid data.
Phone Number: Please enter valid data.
Dates Known: Please enter valid data.

Activities, Honors, Publications, Professional Organizations: (Please list)

If employed, when can you begin work? Please enter valid data.

If presently employed, may we contact your employer to verify your work record? Yes No

If no, please explain: Please enter valid data.

Name & phone number of current supervisor: Please enter valid data.

Reason for leaving present position: Please enter valid data.

Present (or most recent) supervisor(s): Please enter valid data.

Are you Catholic? (Yes or No) REQUIRED Please fill out this field. Please enter valid data.

If yes, which parish: Please enter valid data.

If not Catholic, are you willing to support Catholic teaching and philosophy? (Yes or No) Please enter valid data.

What has attracted you to this position?

Conviction Statement:
“Yes” answers to the following five questions will not necessarily result in denial of employment. The Diocese will consider all the circumstances, including the date and nature of events which have led to the actions described below. Your written explanation will assist the Diocese in determining your eligibility and suitability for employment.

Statement #1 - Conviction

1. Have you ever been convicted of, admitted committing, or are you awaiting trial for any crime (excluding only minor traffic violations not involving any allegations of drug or alcohol impairment)? You must answer “Yes” even if the matter was later dismissed, deferred, vacated, or expunged. If you answer “Yes” you must provide dates of the proceedings, the court where the proceedings occurred, a statement of the accusation against you, and the final disposition of the case (s).
Please select: Yes No
Explanation: Please enter valid data.

Statement #2 - Dismissals

2. Have you ever been dismissed (fired) from any job, or resigned at the request of your employer, or while charges against you or an investigation of your behavior was pending? Please select: You must answer “Yes” even if the matter resolved with any form of settlement or severance agreement, regardless of its terms. If you answer “Yes” you must provide the date of termination of employment, the name, address, and telephone number of the employer (s) and a statement of the alleged reasons for termination.
Please select: Yes No
Explanation: Please enter valid data.

Statement #3 - Revoked Licenses/Certificates

3. Have you ever had any license or certificate of any kind revoked or suspended, or have you in any way been sanctioned by, or is any charge or complaint now pending against you before any licensing, certification or other regulatory agency or body, public or private? If you answer “Yes” you must provide the dates of proceedings, name, address, and telephone number of the agency or body where proceedings took place, a statement of the accusations against you and the final disposition.
Please select: Yes No
Explanation: Please enter valid data.

Statement #4: Misconduct

4. Are you now being investigated for any alleged misconduct or other alleged grounds for discipline by any licensing, certification, or other regulatory body (teacher certification or otherwise) or by your current or any previous employer? If you answer “Yes” you must provide the name, address, and telephone number of the employer or licensing body and a statement of the accusations against you.
Please select: Yes No
Explanation: Please enter valid data.

Statement #5: Crimes Against Children

5. Have you ever been convicted of a dangerous crime against children? If yes, provide details, including date of conviction, court where convicted, sentence imposed, and present status of conviction.
Please select: Yes No
Explanation: Please enter valid data.

Statement #6: Unfulfilled Contracts

6. Have you ever failed or refused to fulfill an employment contract with a school or diocese?
Please select: Yes No
Explanation: Please enter valid data.

Legal for Employment

Are you legally eligible for employment in the United States?
Please select: Yes No
(Proof of US Citizenship or immigration status will be required upon employment.)

By signing this application, I authorize you to request information concerning my education, training, experience, qualifications, and job performance from any former and/or current employer of mine, and I specifically waive any right I have to receive or examine a copy of any written communication regarding employment furnished by any former or current employer of mine.

READ THIS PARAGRAPH BEFORE SIGNING THIS APPLICATION
Every answer I have provided on this application is both complete and truthful. I understand and agree that (1) if any information is omitted from or not filled in on this application, or if any false information is furnished, Light of Christ Catholic Schools will reject my application; (2) if any false information is furnished, I will be ineligible for any future consideration for employment and may be subject to criminal prosecution; and (3) if I am employed by Light of Christ Catholic Schools, I may be dismissed from employment, criminally prosecuted, and if certified, my certificate may be revoked, if it is later determined that I have furnished false information on this application.

Electronic Signature: REQUIRED Please fill out this field. Please enter valid data.

Date: Please enter valid data.

It is the policy of Light of Christ Catholic Schools, pursuant to the Federal and State laws dealing with equal opportunity in employment, not to discriminate in hiring on the basis of age, race, gender, disability or national origin.

Staff employment application

Staff Employment Application