Teacher Application Personal InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Daytime Phone*Cell Phone*Email* Religion*Faith*Parish/Church*Employment InterestsWhat position are you applying for? Please select all that apply: High School Teacher Middle School Teacher Student Support Role Share the subject area(s) you are interested in teaching or the counseling/academic support services you are interested in offering.*Share any additional extracurricular activities, coaching, or clubs are interested in being involved with.*Educational and Professional Training*College or UniversityLocation (City, State)Dates Attended From - ToGraduation Date, Degree Undergraduate DegreeMajor(s)Minor(s)Graduate DegreeGraduate DegreeArea(s) of ConcentrationTeaching, Counseling or Academic Support ExperienceDates From - ToSchoolLocation (City, State)Grade(s) or Subject(s) or Role Other Related Work ExperienceDates From - ToCompany, Job Title (Short job description, if needed)Location (City, State) Professional References (for each of the positions listed above)NameSchool/CompanyDaytime PhoneEmail Background QuestionsDo you possess a valid teaching certificate?* Yes No Do you possess a valid pupil service license specializing in school counseling?* Yes No If yes,State(s)Type(s)/Teaching Area(s)Expiration Date(s) Have you ever had a teaching or 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 explainHave you ever for any reason been suspended, dismissed, or asked to resign a teaching 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 AnswerWhy would you like to work at Cristo Rey Columbus High School?*What are the strengths you bring to the education profession?*What is your understanding of “data-driven instruction” and what experience do you have in a data driven classroom? (Teacher Applicants only)How would you differentiate instruction to meet the needs of the many learners in your class? (Teacher Applicants only)How would you integrate technology into your classroom (we are a 1:1 Chromebook school)? (Teacher Applicants only)How would you describe your classroom management style? (Teacher Applicants only)Where did you hear about this job opening?Cover Letter: Drop files here or Select files Max. file size: 256 MB. Resume: Drop files here or Select files Max. file size: 256 MB. CertificationI 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 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. Δ