Administrative Application

Please complete the form below. Mandatory fields marked *

General Information
  1. If the above address is not your permanent address or you have lived there less than five years, please provide the following information.
  2. Please list any other former name (s) or alias you may be using, or have used in the past:
  1. Yes No
  2. Yes No
  3. Yes No
  4. Yes No
    (Proof of U.S. Citizenship or immigration status will be required upon employment.)

IMPORTANT:Before consideration will be given for employment, the candidate must have on file a complete set of transcripts (copies will be accepted during application process; however, originals will be required if applicant is hired), a copy of applicant’s current Arizona Teaching Certificate, and an up-to-date placement file from a college or university. If applicant is unable to provide a placement file, three recommendations may be substituted.

Out-of-state applicants should write to the Arizona State Department of Education, Teacher Certification Unit, P.O. Box 6490, Phoenix, AZ 85005-6490, or call (602) 542-4367 regarding certification.

When all of these items have been received, a screening interview will be scheduled. The file will be placed in the active applicant file and will receive consideration for openings for which the applicant is certified and has expressed an interest.

It is the policy of Espiritu Community Development pursuant to the Federal and State laws dealing with equal opportunity in employment not to discriminate in hiring on the basis of age, race, gender, disability or national origin.

EDUCATIONAL PREPARATION (Schools attended)
Name of School Location Dates Year of Graduation/
Degree
Elementary:
High School:
Undergraduate:
Graduate:
ACTIVITIES AND HONORS
  1. Please list any activities or sports which you are able to direct or coach successfully at the middle school or high school level:
  2. List any college activities engaged in and any honors received (professional activities, interest, organizations, extent of participation):
  3. List any community activities, organizations or clubs:
REFERENCES
  1. Give four references, including references from superintendents and principals under whom you have taught who have firsthand knowledge of your character, personality, scholarship and teaching ability.
Name Address Title/Position Telephone Years
TEACHING EXPERIENCE (Attach additional pages if needed)
Grade/
Subject Taught
School Supervisor Name City/State Phone Dates
ADMINISTRATIVE EXPERIENCE (Attach additional pages if needed)

List most current first

Name of Institution Supervisor Name City/State Phone Dates
OTHER WORK EXPERIENCE (Attach additional pages if needed.)
Employer &
Supervisor Name
City/State Phone Nature of Work Dates
IMMUNIZATION RECORD INFORMATION
  1. Arizona State Department of Health Services regulations (R9-6-729 and R9-6-742) require that an immunization record for each school employee be on file prior to employment. It shall be a condition of employment that the employee provides Espiritu with proof of immunization for Rubella or Rubeola unless the employee falls within the exemption categories listed below.
  2. All persons born after January 1, 1957 must provide documentation of Rubella (German measles) immunity.
  3. Exceptions to immunization requirement:
  4. Statement signed by licensed physician or state/local health officer affirming that immunization is medically inappropriate. (Must be attached)
  5. Employee provides statement indicating that religious reasons preclude compliance. (Must be attached.)
CURRENTLY EMPLOYED?
  1. Yes No
CONVICTION STATEMENT
  1. “Yes” answers to the following five questions will not necessarily result in denial of employment. Espiritu will consider all the circumstances, including the date and nature of events which have led to the actions described below. Your written explanation will assist Espiritu in determining your eligibility and suitability for employment. Attach additional sheets if necessary.
  2. 1. Have you ever been convicted of, admitted committing, or are you awaiting trail for any crime (excluding only minor traffic violations not involving any allegations of drug or alcohol impairment)? You must answer “Yes” even if the matter was later dismissed, deferred, vacated, or expunged. If you answer “Yes” you must provide dates of the proceedings, the court where the proceedings occurred, a statement of the accusation against you, and the final disposition of the case (s).
  3. Yes No
  4. 2. Have you ever been dismissed (fired) from any job, or resigned at the request of your employer, or while charges against you or an investigation of your behavior was pending? You must answer “Yes” even if the matter resolved with any form of settlement or severance agreement, regardless of its terms. If you answer “Yes” you must provide the date of termination of employment, the name, address, and telephone number of the employer (s) and a statement of the alleged reasons for termination.
  5. Yes No
  6. 3. Have you ever had any license or certificate of any kind (teaching certificate or otherwise) revoked or suspended, or have you in any way been sanctioned by, or is any charge or complaint now pending against you before any licensing, certification or other regulatory agency or body, public or private? If you answer “Yes” you must provide the dates of proceedings, name, address, and telephone number of the agency or body where proceedings took place, a statement of the accusations against you and the final disposition.
  7. Yes No
  8. 4. Are you now being investigated for any alleged misconduct or other alleged grounds for discipline by any licensing, certification, or other regulatory body (teacher certification or otherwise) or by your current or any previous employer? If you answer “Yes” you must provide the name, address, and telephone number of the employer or licensing body and a statement of the accusations against you.
  9. Yes No
  10. 5. Have you ever been convicted of a dangerous crime against children as defined in ARS 13.604.01?
  11. Yes No
  12. If so, provide details, including date of conviction, court where convicted, sentence imposed, and present status of conviction.

By signing this application, I authorize you to request information concerning my education, training, experience, qualifications, and job performance from any former and/or current employer of mine, and I specifically waive any right I have under ARS 23-1361.B or otherwise to receive or examine a copy of any written communication regarding employment furnished by any former or current employer of mine.

READ THIS PARAGRAPH BEFORE SIGNING THIS APPLICATION

Every answer I have provided on this application is both complete and truthful. I understand and agree that (1) if any information is omitted from or not filled in on this application, or if any false information is furnished, Espiritu will reject my application; (2) if any false information is furnished, I will be ineligible for any future consideration for employment and may be subject to criminal prosecution; and (3) if I am employed by Espiritu, I may be dismissed from employment, criminally prosecuted, and if certified, my certificate may be revoked, if it is later determined that I have furnished false information on this application.

I understand, at the time of hire, I will be responsible for costs incurred to complete fingerprinting and background investigation.

  1. Please make sure that your file name does not contain any spaces. Thank you.

Please enter the letters on the left to the area below.
Verification Code: (* required)
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