Application

APPLICATION FOR EMPLOYMENT

Required fields are marked with an asterisk (*).

PERSONAL INFORMATION

Name *First Name *Last Name *Social Security #

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Present Address *Street Address *City *State *Zip Code

Permanent Address *Street Address *City *State *Zip Code

Contact *Phone Number

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Cell / Alternate Number

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*Email

*Are you a US Citizen or an alien authorized to work in the United States?

EMPLOYMENT DESIRED

*Position *Do you have transportation? *Date you can start:

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*Desired Salary

*Days Available:
*Hours Available:
*Core Area(s) of Expertise:

*Do you hold a current Virginia teaching licensure? *Expiration Date:

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EDUCATION

High School School Name Location No. of Years Graduation Year Subjects Studied or Degree

College School Name Location No. of Years Graduation Year Subjects Studied or Degree

Post-Collegiate School Name Location No. of Years Graduation Year Subjects Studied or Degree

Trade/Business Correspondence School School Name Location No. of Years Graduation Year Subjects Studied or Degree

EMPLOYMENT

(List below your last three employers, starting with the most recent one.)

Former Employer From (mm/yyyy)

To (mm/yyyy)

Employer Name Contact Person Contact Phone Number

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Your Position Reason for Leaving

Former Employer From (mm/yyyy)

To (mm/yyyy)

Employer Name Contact Person Contact Phone Number

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Your Position Reason for Leaving

Former Employer From (mm/yyyy)

To (mm/yyyy)

Employer Name Contact Person Contact Phone Number

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Your Position Reason for Leaving

Do you have tutorial experience? No. of Years Experience: Describe your experience(s):

REFERENCES

(List below the names of persons not related to you, whom you have known at least one full year.)

Reference 1 Name Phone Number

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Relationship (Occupational/Personal) Years Acquainted

Reference 2 Name Phone Number

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Relationship (Occupational/Personal) Years Acquainted

Reference 3 Name Phone Number

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Relationship (Occupational/Personal) Years Acquainted

MISCELLANEOUS INFORMATION

*This position requires finger printing. Were you ever convicted of a crime?

If yes, explain:

*Drug testing and tuberculosis screening are also required. Do you agree to acquire these and/or provide documentation of your screenings?

Consent / Authorization

* I certify that the information provided in this application is true and complete to the best of my knowledge and that I understand that, if employed, falsified statements shall be grounds for dismissal. I authorize investigation of all statements contained and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing the same. I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time at the discretion of Aligned Interventions Educational Services.