GWA Application for Employment

Position for which you are applying*:
Last Name*:
First Name*:
M.I.*:
Email*:
Complete Street Address*:
City*:
State*:
Zip Code*:
Phone Number*:
Cell Number*:
Alternate Contact, if applicable
Contact Name:
Phone Number:

Certification: (Administrative, Certified and Substitute Teachers only)

What type of Utah certificate do you hold?:
Expiration Date:
Endorsement(s) shown on Certificate:
In which grades/subjects are you qualified to teach?:
Which do you prefer to teach?:
I have arranged for my placement file to be sent from:
Are you now under contract with another school district?:
If yes, which district?:

Previous Teaching Experience

School 1
District/School:
City/State:
Grade/Subject:
Date from:
Date to:
School 2
District/School:
City/State:
Grade/Subject:
Date from:
Date to:
School 3
District/School:
City/State:
Grade/Subject:
Date from:
Date to:
If the above experience record is interrupted by one year or more, state where and how you were occupied in the interval.:

All Applicants

Education

Undergraduate Education
Most recent college, university, or educational entity attended
Name:
Location:
Dates Attended:
Degree Received and Area of Study:
Other education, training, or honors:

Employment History

(Please list most recent employment first)
Company/Employer 1
Name*:
Address*:
Position (grades taught if education)*:
Employed from (month/year)*:
Employed to (month/year)*:
Reason for leaving (be specific)*:
May we contact this employer?*:
Name & Title of Supervisor*:
Phone*:
Company/Employer 2
Name*:
Address*:
Position (grades, taught if education)*:
Employed from (month/year)*:
Employed to (month/year)*:
Reason for leaving (be specific)*:
May we contact this employer?*:
Name & Title of Supervisor*:
Phone*:
Company/Employer 3
Name:
Address:
Position (grades, taught if education):
Employed from (month/year):
Employed to (month/year):
Reason for leaving (be specific):
May we contact this employer?:
Name & Title of Supervisor:
Phone:
Company/Employer 4
Name:
Address:
Position (grades, taught if education):
Employed from (month/year):
Employed to (month/year):
Reason for leaving (be specific):
May we contact this employer?:
Name & Title of Supervisor:
Phone:

Personal References

Reference One
Name*:
Relationship*:
City & State*:
Contact Number*:
Years Known*:
Reference Two
Name*:
Relationship*:
City & State*:
Contact Number*:
Years Known*:
Reference Three
Name*:
Relationship*:
City & State*:
Contact Number*:
Years Known*:

As a condition of this application process, I authorize George Washington Academy (GWA) to seek information from employers and colleagues regarding mywork habits, performance record, ability to have positive work interactions, technical skills, and any other job-related information which will enableGWA to evaluate my suitability for employment. By signing below, I will waive all future claims against former and current employers and GWA forinformation obtained through the reference checking process.I understand that GWA is required to request this information. Pursuant to Utah State Law 53A-15-1511 and 34-42-1, by signing this I authorize GeorgeWashington Academy to contact current and previous employers and authorize them to disclose information regarding any employment action taken ordiscipline imposed against me for the physical abuse or sexual abuse of a child or student. If an LEA (Local Education Agency) or other employer ingood faith discloses information that is within the scope of this release, the LEA or other employer is immune from civil and/or criminal liabilitybased upon the applicable law.* Positions will be filled without regard to race, religion, national origin, sex, or disability.

I HEREBY VERIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY MISSTATEMENT OR MISINFORMATIONIS GROUNDS FOR DISMISSAL. IF HIRED, I HEREBY AGREE TO ABIDE BY THE POLICIES OF GWA. A CRIMINAL BACKGROUND CHECK WILL BE REQUIRED PRIOR TO BEINGEMPLOYED, AND THAT I WILL BE RESPONSIBLE FOR THE CRIMINAL BACKGROUND CHECK FEE. I UNDERSTAND THAT IF I AM SELECTED FOR A POSITION MY EMPLOYMENT WILL BECONTNGENT UPON COMPLETION OF A BACKGROUND CHECK WITH RESULTS ACCEPTABLE TO GEORGE WASHINGTON ACADEMY.

Applicant's Signature*:
Date*:

Supplemental Questionnaire

Name*:
Date*:
Position Applied For*:

Note: It is important that you give complete and truthful answers to the following questions. If you answer “YES” to any of them, please provide your explanations(s) on a separate sheet of paper. Include convictions resulting from a plea of nolo contendere (no contest), and information about any expungement.

Omit: traffic fines of $100.00 or less.

We will consider the date, facts, and circumstances of each event you list. In most cases, you can still be considered for GWA employment. However, if you fail to tell the truth or fail to list all relevant events or circumstances, this may be grounds for not hiring you, or grounds for dismissal after you begin work.

Have you ever been arrested for, convicted of, or forfeited collateral for any felony or misdemeanor violation?*:
Have you ever been arrested for, convicted of, or forfeited collateral for any firearms or explosives violation?*:
Are you now under investigation for misconduct or any violation of law?*:
Have you ever been convicted by a military court-martial?*:
Have you been found pursuant to a criminal, civil or administrative action to have committed a sexual offense against a minor child or had any substantial child abuse charges filed against you?*:
Have you voluntarily resigned or surrendered a professional license or certificate in the face of a charge relating to incidents in items 1-6 above?*:
Are you now under investigation, on notice of warning, or under probation for any concern related to your employment, maintaining a license, orprofessional certificate?*:
During the last 10 years, have you been fired from any job for any reason, did you quit after being told that you would be fired, or did you leave by mutual agreementbecause of specific problems?:
Does GWA employ any relative(s) of yours, either by blood or marriage? If “YES”, please list each one by name and relationship (use separate sheet, ifnecessary).*:
Relative(s) Name:
Relationship:
Position:
Relative(s) Name:
Relationship:
Position:

I HEREBY VERIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY MISSTATEMENT OR MISINFORMATION IS GROUNDS FOR DISMISSAL. IF HIRED, I HEREBY AGREE TO ABIDE BY THE POLICIES OF GWA. A CRIMINAL BACKGROUND CHECK WILL BE REQUIRED PRIOR TO BEING EMPLOYED, AND THAT I WILL BE RESPONSIBLE FOR THE CRIMINAL BACKGROUND CHECK FEE. I UNDERSTAND THAT IF I AM SELECTED FOR A POSITION MY EMPLOYMENT WILL BE CONTINGENT UPON COMPLETION OF A BACKGROUND CHECK WITH RESULTS ACCEPTABLE TO GEORGE WASHINGTON ACADEMY.

Employment with GWA is “At-Will.” Both the employee and George Washington Academy have the right to terminate the employment relationship at any time for any reason or no reason at all, and is not intended to create nor is to be construed to constitute a contract between GWA and any of its employees. Each employee acknowledges that he/she is an “At-Will” employee. This “At-Will” relationship may not be modified by any oral or implied agreement. Any modification to the “At-Will” relationship must be in writing and signed by the President of the Board.

Applicant’s Signature*:
Date*:
Upload Resume*:
 

Contact Us

2277 South 3000 East
St. George, UT 84790

Phone: 435-673-2232  | Fax: 435-673-0142

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