Employee Application

Personal Information

First name

Last name

Phone number

Social Security Number

City

State

Zip

Home Phone

Cell Phone

Alternate Email Address

Desired Employment

Please select between 1–4 to rank your desired placement.

What position are you applying for?

Electives only (specify)

List specific courses you are interested in teaching

Date you can start at Providence Academy?

Education

High School

City

State

Year Diploma Received

College (Undergraduate)

College

City

State

Year Degree Received

GPA

College (Graduate)

College

City

State

Year Degree Received

GPA

Past Employment

List your last two employers, starting with the most recent.

Current/Former Employer

Name of present/last employer

Job Title

Address

City

State

Zip

Starting Date

Leaving Date

Starting Salary

Ending Salary

Name of supervisor

Title

Phone

Description of work

Reason for leaving

Previous Employer

Name of present/last employer

Job Title

Address

City

State

Zip

Starting Date

Leaving Date

Starting Salary

Ending Salary

Name of supervisor

Title

Phone

Description of work

Reason for leaving

Background Information

List all certifications (education, trade, associations) current or expired that you hold

Have you ever been convicted of a felony or misdemeanor? (If yes, please explain)

Have you ever been accused of, participated in, or been convicted of sexual misconduct?

Have you been terminated with any company or from any position? If yes, please explain.

Please describe any serious illnesses (current or past) that could interfere with your ability to perform the job.

If you have taught or instructed at a school in the past, have you ever had your contract not renewed? If yes, please explain.

References

Please list four references — non-relatives.

Reference 1

Name

Email Address

Phone

How long have you known them?

Reference 2

Name

Email Address

Phone

How long have you known them?

Reference 3

Name

Email Address

Phone

How long have you known them?

Reference 4

Name

Email Address

Phone

How long have you known them?

Church Membership

Currently at

How long?

Describe your involvement and activities at church

Pastor / Spiritual Reference

Name

Email Address

Phone

How long have you known them?

Personal Information

Please describe your philosophy of Christian education.

How do you promote Christian values in your home?

Professional organizations / hobbies / activities

Are there any points of the PCCA handbook which are inconsistent with you? If yes, please explain.

Service Record (if applicable)

Branch of Service

Discharge Date

Rank

If no, please explain

Authorization for Investigative Report

By submitting, you authorize Providence Academy to obtain an investigative consumer report for employment purposes.

Full Legal Name

Aliases

Address

City / State

Zip

Date of Birth

SSN

Driver's License #

State Issued

File Attachments

Resume

College Transcript

Statement of Faith

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