Employment Application

4938 Beatrice Drive Columbus, OH 43227

Phone 614-864-5332 Fax 614-864-5381

For Office Use Only

Date Received: _______________

Date of Interview: _____________

Date of Hire: _________________

Position: _____________________

GENERAL INFORMATION

Name ____________________________________________________________________________	Home Phone # __________________________ First	Middle	Last
Cell Phone # ____________________________

Address ___________________________________________________________________________	Email ___________________________________ Street	City	State	Zip

Position(s) Applying for: _____________________________________________________________ Referred By: ________________________________________ ______________________________________________________________________

EDUCATIONAL INFORMATION

School
	Name
	Major
	Minor
	Degree
	Graduated

High School
			Yes No

College
					Yes
No

College
					Yes
No

Graduate School
					Yes
No

Graduate School
					Yes No

Other

Are you certified or licensed in Ohio? _________________ Certificate # ______________________________________

If yes, what certificates, licenses, or endorsements do you have? ____________________________________________

____________________________________________________________________________________________________

If no, have you made application for certification? ____________ What date was it submitted?_________________

What other skills, trades, or qualifications do you have specific to your desired position? _______________________

____________________________________________________________________________________________________

PROFESSIONAL EXPERIENCE

Employer’s Name/City/State
	Position
	Grade/Subject/Skills/Duties
	From - To
	Reason for Leaving

					

					

Please include your resume along with this application.

PROFESSIONAL REFERENCES

Please list the names of superintendents, principals, supervisors, and/or others who closely observed your work.

	Name	
		 Address	 
	 	Email	               
		Phone Number	

				

ADDITIONAL INFORMATION

Are you able to perform the essential functions of the position you are applying for with or without reasonable

accommodation? ______ What reasonable accommodation, if any, would you request? _______________________

____________________________________________________________________________________________________

If hired, are you able to submit proof that you are legally eligible for employment in the U.S.? _________________

Have you ever been discharged or asked to resign from a current or a prior position? _________________________

If yes, please explain _________________________________________________________________________________

____________________________________________________________________________________________________

Have you ever surrendered a teaching certificate, license, or permit? _______ If yes, please explain______________

____________________________________________________________________________________________________

Are you interested in coaching or leading after school clubs? _______ If yes, which one(s)? ____________________

____________________________________________________________________________________________________

SIGNATURE

By signing below, I acknowledge that all the information provided is true and verifiable to the best of my knowledge. I also authorize Patriot Preparatory Academy to contact my references, perform a background check, and verify all information provided. Any falsification of information will render the application void. ANY PERSON WHO KNOWINGLY MAKES A FALSE STATEMENT IS GUILTY OF FALISIFCATION UNDER SECTION 2921.13 OF THE REVISED CODE, WHICH IS A MISDEMEANOR OF THE FIRST DEGREE.

EQUAL OPPORTUNITY EMPLOYMENT

Patriot Preparatory Academy’s policy is to hire and promote individuals who best meet the requirements of available positions and who have the best potential for advancement. It is our policy to provide Equal Employment Opportunity in full compliance with all applicable laws, including Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act, the Age Discrimination in Employment Act, the Equal Pay Act, and the state fair employment practices laws.

In keeping with this policy, applicants for employment, recruitment, hiring, transfer, promotion, pay, benefits, lay-off, demotion, or discharge will be made without regard to race, color, religion, sex, national origin, age, handicap, or disability.Persons who believe that they have not been afforded equal treatment in accordance with this policy should contact the Superintendent, who will present the concern to the PPA Board. All complaints of unequal treatment will be fully investigated and corrective action taken where required.

Signature _______________________________________________________ Date __________________________