Counselor Application - Cristo Rey Columbus High School

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Daytime Phone*

Cell Phone*

Email*

Religion*

Faith*

Parish/Church*

Employment Interests

Counseling Area(s)*

Extra-Curricular Interests (Coaching, activities, etc.)*

Educational and Professional Training

College or University	Location (City, State)	Dates Attended From – To	Graduation Date, Degree

Undergraduate Degree

Major(s)	Minor(s)

Graduate Degree

Graduate Degree	Area(s) of Concentration

Other Related Work Experience

Dates From – To	Company, Job Title (Short job description, if needed)	Location (City, State)

Professional References (for each of the positions listed above)

Name	School/Company	Daytime Phone	Email

Background Questions

Do you possess a valid counseling license?*

Yes
No

If yes,

State(s)	Type(s)/Counseling Area(s)	Expiration Date(s)

Have you ever had a counseling credential denied, suspended, or revoked?*

Yes
No

If yes, please explain:

Have you ever failed or refused to fulfill an employment contract with any school?*

Yes
No

If yes, please explain

Have you ever for any reason been suspended, dismissed, or asked to resign a counseling position?*

Yes
No

If yes, please explain:

Have you ever been convicted of a crime? (excluding minor traffic violations or convictions that have been sealed, expunged, or legally eradicated)*

Yes
No

If yes, briefly describe the nature of the crime(s), the date and place of the conviction, and the legal disposition of the case:

After employment, can you submit verification of your legal right to work in the United States?*

Yes
No

Would your involvement (attendance, participation, supervision) in religious activities make you feel uncomfortable or compromise any of your own personal beliefs?

Yes
No

If yes, please explain:

Short Answer

Why would you like to work at Cristo Rey Columbus High School?*

What are the strengths you bring to the counseling profession?*

Where did you hear about this job opening?

Cover Letter:

Drop files here or

Max. file size: 256 MB.

Resume:

Drop files here or

Max. file size: 256 MB.

Certification

I hereby certify that all the information given in the application form and any supporting documentation (resume, transcripts, credentials, etc.) is true, complete, and correct. I understand that any misrepresentations or omissions shall be sufficient cause for disqualification or, if hired, dismissal. I authorize investigation of all statements contained in this application and any supporting documentation. I further authorize Cristo Rey Columbus to secure information from former employers, educational institutions, governmental agencies, social media or any references I have provided and for those parties to provide information concerning my experience. I hereby release and hold harmless all parties from any liabilities arising from such investigation and verification.

I consent.