Please print the application and mail it to the NCS
Personnel Committee.
Neighborhood Charter School, 688 Grant Street, Atlanta, Georgia 30315
404.624.6226 ph, 404.624.9093 fx

Neighborhood Charter School

PROFESSIONAL EMPLOYMENT APPLICATION

Position Applied For: ____________________________________________

APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment. Please answer all questions completely and accurately. False or misleading statements on this form or during an interview will result in the termination of the application process or, if discovered after employment, terminating employment. PLEASE DO NOT WRITE “SEE RESUME”.

PERSONAL INFORMATION

Last Name First Middle	Social Security Number
Address	Apartment number
City State Zip Code	Telephone Number
Apartment number	Email Address

CERTIFICATION

Georgia Certification? Yes___ No ___ Level (L-5) ___________

Expiration Date __________

Endorsements ____________________________________________

Certification from outside of Georgia? Yes___ No ___ State ___________

List any teaching and administrative licenses you have held. (Include those licenses you are eligible to receive.)

State

Type of License

Endorsements

Have you taken the PRAXIS-Leadership exam? (If yes, attach scores) Yes___ No ___

EDUCATION List below all schools, colleges or universities that you have attended. Begin with most recent

Colleges/Universities	Dates Attended From To	Major	Minor	Degree	Date of Degrees

TEACHING EXPERIENCE Begin with the most recent

School and Location (Include address and phone number)	Grade/ Subject	Dates	Principal/Supervisor	Phone Number

OTHER WORK EXPERIENCE Begin with the most recent

Employer and Address	Dates To From	Supervisor	Position Held	Reason for leaving

REFERENCES Three (3) professional references are required.

Name

Phone Number

Relationship

1. List any experiences you have had working with ethnically diverse students.

2. Describe any experience you have had with Constructivist curriculum or any like model.

3. Detail the computer and software applications with which you are familiar. Explain how you integrate these applications into instruction and education.

4. List experiences where you have worked with students in special education, ESL, at risk and or alternative programs.

5. What community base, parental involvement or service activities have you been involved in the last five (5) years?

6. What are your professional goals for the next five (5) years?

PROFESSIONAL AND PERSONAL ACTIVITIES

Professional Narrative

Describe in narrative form some highlights of your life, including why you chose a career in education, jobs held, hobbies and special interests. It should also indicate why you are seeking an opportunity at a charter school.

Please attach your narrative to the back of the application..

GENERAL INFORMATION

1. Were you ever in the armed forces? Yes ____ No ____

2. Were you honorably discharged? Yes ____ No ____

3. Are you a citizen of the United States? Yes ____ No ____

4. If No, do you have a legal right to work in this country? Yes ____ No ____

(Attach copy of ALIEN REGISTRATION CARD)

CONTRACTS / LICENSURE AND CRIMINAL RECORD

Answer each question yes or no. You must attach a copy of the court disposition or judge's sentencing order if you answer “yes” to questions 5 or 6. You must attach supporting documentation and a written explanation if you answered “yes” to any of the questions below. FAILURE TO COMPLETE ALL OF THIS SECTION WILL RESULT IN YOUR APPLICATION NOT BEING CONSIDERED.

5. Have you been convicted of or pled nolo contendre on any of the following, including, but not limited to: murder, sexual or physical assault, rape, child molestation, kidnapping, manslaughter, extortion, sexual misconduct with a minor, indecent liberties, incest, unlawful imprisonment, child abuse or neglect, abduction for immoral purposes, failure to secure medical attention for an injured child, pandering, crimes against nature involving children, malicious harassment, patronizing a juvenile prostitute, child abandonment, violation of a child abuse protective order, obscenity offenses, possession or distribution of drugs, arson, use of a firearm in the commission of a felony, child buying or selling, prostitution, felony indecent exposure, larceny, embezzlement or any of these crimes as may be renamed in the future?

Yes ____ No ____

6. Have you been convicted of any felony or misdemeanor other than those listed above in question 5 or pled nolo contendre, or are you now under investigation for any such offense, other than a minor traffic offense? For the purpose of this application DUI/ DWIs must be reported.

Yes ____ No ____

7. Have you ever resigned or been discharged from any position, including the Armed Forces while under suspicion of having engaged in criminal, immoral or unprofessional conduct, or are you now under investigation for any such charge?

Yes ____ No ____

8. Have you ever surrendered your teaching or administrative certificate/license/permit, or had one denied, revoked or suspended or is any investigation or adverse action now pending against you?

Yes ____ No ____

9. Have you ever had any disciplinary action taken against you by a previous employer, including written reprimand, suspension, demotion, non-renewal, termination or any other form of disciplinary action?

Yes ____ No ____

INVESTIGATION CONSENT, RELEASE FROM LIBILITY AND AGREEMENT FORM

I CERTIFY, that I have never been convicted of a felony, a crime or moral turpitude, an offense involving the physical molestation, physical or sexual abuse or rape of a child and that I have never been the subject of a founded case of child abuse and neglect.

Signature _____________________________________________________

Making a materially false statement regarding these offenses is a misdemeanor. Such a conviction shall be grounds for the Georgia Professional Standards Commission to revoke your teaching certificate. An applicant who is unable to complete the above certification will not be considered for employment with the Neighborhood Charter School.

I authorize the Neighborhood Charter School (NCS) to make an investigation of any personal, educational, vocational or employment history. I further authorize any former employer, person, firm, corporation, educational or vocational institution, or government to provide the NCS with information they have regarding my performance, character, and general reputation. I discharge NCS and those who provide information from any liability as a result of furnishing this information.
I have identified that all statements and data provided are true and correct to the best of my knowledge. I agree that falsification will constitute disqualification of my application or dismissal from employment form the Neighborhood Charter School.
I understand that any offer of employment is contingent upon Governing Board approval and an acceptable outcome of criminal records check. It is further understood that the criminal records check is conducted at my expense.
If employed, I understand that I shall serve successfully the prescribed probationary period, during which time my suitability for the position will be determined.

Print Name Signature Date

____________________________________________________________________________________

Neighborhood Charter School, 688 Grant Street, Atlanta, Georgia 30315