CCA TEACHER APPLICATION

indicates a required answer

PERSONAL INFORMATION
1. *

First Name:
2. *

Last Name:
3. *

Middle Name:
4. 

List any other names used at any other time:
5. *

Social Security Number:
6. *

Home Phone:
7. *

Business Phone:
8. *

Address (Street, City, State, Zip):
9. *

Email Address:
10. 

Other Phone:
11. *

Church Membership:

 

 

EDUCATION
12. *

Education:

Copies of all College and/or University transcripts, both undergraduate and graduate, must be filed with your application or soon after it has been submitted.
13. 

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14. 

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15. 

Education (Additional):
16. 

Education (Additional):
17. 

Education (Additional):
18. 

If you have not yet completed your Bachelor's degree, please list the number of hours needed to complete your degree:
19. 

What is the expected date of completion?

 

 

CERTIFICATION

(Lack of professional certification is not a bar to employment in all cases)
20. *

Do you hold a teacher’s certificate?

 (1 required)
Yes No
21. 

If yes, date issued:
22. 

Please attach a copy:

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23. 

CERTIFIED SUBJECT AREA:
24. 

SPECIFY STATE OF CERT.:
25. 

CLASS (A-Bachelor’s; G-Master’s):
26. 

EXPIRATION DATE:
27. *

TEACHING POSITION FOR WHICH YOU ARE APPLYING:

Use your Ctrl & Shift keys to select multiples.
28. *

Please list any extra-curricular programs for which you would feel qualified to lead:

 

 

WORK-RELATED EXPERIENCE

Please list positions you’ve held that have prepared you for the work for which you are applying.
29. *

Place of Employment:
30. *

Position:
31. *

Longevity of Position:
32. *

Reason for Leaving:

 

 
33. 

Place of Employment:
34. 

Position:
35. 

Longevity of Position:
36. 

Reason for Leaving:

 

 
37. 

Place of Employment:
38. 

Position:
39. 

Longevity of Position:
40. 

Reason for Leaving:

 

 

STUDENT TEACHING

If student teaching was completed within the last three years, supply the following information:
41. 

School:
42. 

Address (Street, City, State, Zip):
43. 

Grades/Subjects:
44. 

Dates:
45. 

Cooperating Teacher:
46. 

Phone:
47. 

College/University:
48. 

College Supervisor:
49. 

Phone Number:

 

 

REFERENCES

Please give four references with phone numbers and email addresses. Include at least two professional references and one reference
who can comment on your Christian faith. Unless noted otherwise, we will assume permission to contact these people.

 
50. *

Name:
51. *

Phone:
52. *

Email:
53. *

Relationship to Applicant:
54. *

#Years Known:

 

 
55. *

Name:
56. *

Phone:
57. *

Email:
58. *

Relationship to Applicant:
59. *

#Years Known:

 

 
60. *

Name:
61. *

Phone:
62. *

Email:
63. *

Relationship to Applicant:
64. *

#Years Known:

 

 
65. *

Name:
66. *

Phone Number:
67. *

Email Address:
68. *

Relationship to Applicant:
69. *

#Years Known:

 

 

PHILOSOPHY QUESTIONS

Please answer the following questions succinctly. 

 

EDUCATIONAL VIEWS AND VALUES
70. *

1. What does a Christian education mean to you?
71. *

2. Why do you want to teach at CCA?
72. *

3. Who have been the most influential people in your life?
73. *

4. What are the goals of a good education?
74. *

5. What part does discipline play in the classroom?

 

RELIGIOUS VIEWS AND EXPERIENCE
75. *

1. What must one believe to be a Christian?
76. *

2. Describe how you came to faith in Jesus Christ.
77. *

3. How does your Christianity affect the way you go about teaching?
78. *

4. Can you unreservedly subscribe to the mission and faith statement of Cornerstone Classical Academy?

CCA Mission Statement

 (1 required)
Yes, I agree No, I do no agree

 

 

GENERAL BACKGROUND INFORMATION

You must give complete answers to all questions. If you answer “Yes” to any question, you must list all
offenses, and for each conviction provide date of conviction and disposition, regardless of the date or location of occurrence. Conviction of a criminal offense is not a bar to employment in all cases. Your answers will be verified with appropriate police records.

 

“Professionally disciplined” means the annulment, revocation or suspension of a professional license or
certificate or the receipt of a letter of reprimand from an agency, board or commission of state government.
“Criminal Offense” includes all felonies and misdemeanors.

Conviction includes adjudication of guilt, pleas of “nolo contendre” (no contest), and deter- minations before courts, juries, judges or magistrates which resulted in fines, sentences or probation. You may omit minor traffic violations.
79. *

Have you been fired, dismissed or non-renewed from any job for any reason?

 (1 required)
Yes No
80. *

Have you quit a job after being notified that you would be fired, dismissed or non-renewed, or after being
notified that you would be recommended for firing, dismissal or non-renewal?

 (1 required)
Yes No
81. *

Have you ever been professionally disciplined in any state?

 (1 required)
Yes No
82. *

Are you subject to any visa or immigration status which would prevent lawful employment?

 (1 required)
Yes No
83. *

Have you ever been convicted of a criminal offense?

 (1 required)
Yes No
84. *

Are you currently charged with a criminal offense?

 (1 required)
Yes No
85. 

Note: If you answered “Yes” to any of the above questions, please provide a detailed explanation, including your name, dates, and list of all
offenses. For any conviction, provide the date of conviction and disposition, and attach it to this application. 
86. 

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BACKGROUND AND CRIMINAL HISTORY CHECKS

On request, each applicant must submit to the school a completed Criminal History Release Authorization
Form. Any offer of employment that the school extends to an applicant is conditional upon the successful
processing of his or her criminal history and background check results that are acceptable to the school.

 

 

CERTIFICATION AND RELEASE AUTHORIZATION
87. *

I certify that all of the statements made by me are true, complete and correct to the best of my knowledge
and belief, and are made in good faith. I understand that any misrepresentation of information shall be
sufficient cause for rejecting my application, withdrawing of any offer of employment, or terminating my
employment.

I hereby authorize any and all of my previous employers and/or supervisors to release any and all of my
personnel records, and to respond fully and completely to all questions that officials of Cornerstone Classical
Academy may ask regarding my prior work history and performance. I will hold such previous employers and/or
supervisors harmless of any and all claims that I might otherwise have against them with regard to statements
made to Cornerstone Classical Academy. I further authorize CCa officials to investigate my background, now or
in the future, to verify the information provided, and I release from liability all persons and/or entities
supplying information regarding my background.
By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
88. *

Date:

 

 

POLICY OF NON-DISCRIMINATION

Cornerstone Classical Academy does not discriminate on the basis of race, color, national or ethnic origin in
the administration of its educational, admission, financial aid or employment policies, or any other programs
administered by the school.