Ridgeview Global Studies Academy Online Employment Application
2009-2010

Personal Information

First Name
Last Name
Sex	Male Female

            Social Security Number: 

Address

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
Work Phone
E-mail

Are you a citizen of the United States?

Yes No

Are you retired from a Florida State Retirement System?

Yes No

Select any/all of the following options that you are applying for at this time:

Administration    Kindergarten      1st Grade         2nd Grade       
3rd Grade         4th Grade         5th Grade         Resource Teacher
Guidance          Media             

Select any/all of the following options that you are applying for at this time:

Paraprofessional  Secretary         Technology        Bus Driver      
Food Service      Substitute Teacher

Personal Information

High School

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

College/University

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

Other Education

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

Employment Information

From: To: 
Employer:   Street:
City, State, Zip:  Phone:
Supervisor:
Reason for Leaving:

From: To: 
Employer:   Street:
City, State, Zip:  Phone:
Supervisor:
Reason for Leaving:

From: To: 
Employer:   Street:
City, State, Zip:  Phone:
Supervisor:
Reason for Leaving:

Do you currently hold a valid Florida Educator's Certificate?

Yes No

Have you applied for a Florida Educator's Certificate?

Yes No

If yes, when?

-- mm/dd/yy

Have you ever had a teaching certificate suspended or revoked by the state of Florida or any other state?

Yes No

Are you under contract with any school system at the present time?

Yes No

If yes, name the system.

List other states in which you hold a valid teaching certificate.

Personal References
(Please include one reference of a previous employer, if possible)

Name 
Address 
City, State, Zip
Phone   
Title/Work Position 
Relationship 

Name 
Address 
City, State, Zip
Phone   
Title/Work Position
Relationship 

Name 
Address 
City, State, Zip
Phone   
Title/Work Position
Relationship 

Have you ever been convicted or found guilty of a criminal offense other than a minor traffic violation (DUI is NOT a minor traffic violation) and such record(s) was sealed or expunged?

Yes No

Other Information

Have you ever been arrested and/or convicted, found guilty, had adjudication withheld, or entered a plea of nolo contendere (no contest) to a crime other than a minor traffic violation? (DUI is not a minor traffic violation) Florida Law requires a YES or NO answer. Please attach a certified copy of legal disposition and/or court document related to each arrest. Any record that has not been sealed or expunged must be reported in this section.

Yes No

If yes, where and when did arrest take place?

Where ?   
When? 

I hereby represent that each answer to a question herein and all other information otherwise furnished is true, complete, and correct. I further represent that such answers and information constitute a full and complete disclosure of my knowledge with respect to the question or subject to which the answer of information relates. I understand that any incorrect, incomplete, or false statements or information furnished by me will subject me to discharge at any time. In the event that I am employed by Ridgeview Global Studies Academy, I agree to comply with all rules and regulations. I hereby authorized my former employers to give any information regarding my employment with them and, in addition, to furnish any other information they have concerning me. I understand that I will participate in a drug screening when offered employment and that I must have negative drug screen results to be employed. If my drug screen is positive, I understand that I may not be considered for employment for one year after the date of the positive test. I understand that I will be fingerprinted as a matter of protection and identification, and will be on probationary status pending fingerprint processing and payment of fees associated with the fingerprint process. I will have a physical exam by a qualified physician as a condition of employment. I authorize the release of all information from any and all law enforcement agencies where protected under the Privacy Act. All information contained in the applicant's file is public information subject to inspection under the Public Records Act, Florida Statute 119.07, unless specifically excluded from the Public Records Act, under Florida School Law 1012.31. It is the policy of Ridgeview Global Studies Academy not to discriminate against employees or applicants for employment on the basis of race, color, religion, sex, national origin, marital status, age, or disability. Sexual harassment is a form of employee misconduct, which undermines the integrity of the employment relationship, and is prohibited. This policy shall apply to recruitment, employment, transfers, compensation, and other terms and conditions of employment. I have read and fully understand this agreement and its contents.

Yes No