ࡱ> M 77bjbj== )WW;)lFFFZ///8>/$b/ZXP22(:2:2:2:2333SOUOUOUOUOUOUO$Q SyOF33333yO_5:2:2P_5_5_538:2F:2SO_53SO_5_5 >VC@.FC:22 @HB;Z+/)3(GC C (P0XPSCTNTQ3NTC_5ZZ An Equal Opportunity Employer EEO Information Not for Interview Purposes In accordance with Equal Employment laws, we are required to maintain statistical data on all applicants. We ask for your cooperation in completing and returning the following information. This form will be separated from your application and not used in the screening or interviewing processes. Name:First Middle LastAddress:Street Apt. #City State ZipDay Phone #:Date of birth:Sex: , Male , Female Race/Ethnic Group:, American Indian , Asian/Pacific Islander , Hispanic, Black , White , Other (specify) __________ If you are a disabled veteran or have a physical or mental disability, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe manner. This information will not adversely affect any consideration you may receive for employment. If you wish to be identified, sign here: Check the box that describes your status: ( Disabled Veteran ( Vietnam Veteran ( Disabled Individual Signature of Applicant: Date: Nondiscrimination & Compliance Statement The Csar Chvez Schools are an equal opportunity education institution and will not on the basis of race, color, national origin, gender, sexual orientation, age, disability or any other capacity protected by law discriminate in its admission to or employment in its educational programs or activities as required by Title II of the ADA, Title VI, Title IX, and Section 504. If you believe you have been discriminated against for these reasons on consideration of your application, please notify Mitzi Burby, Title IX Coordinator of the Chvez Schools at 709 12th Street, SE, Washington, DC 10003, phone: 202.547.3975; fax: 202.547.3449; email: mitzi.burby@Chvez schools.org. It is also your right to notify the Equal Employment Opportunity Commission, Office of Federal Contract Compliance Programs, Department of Education or any appropriate local or state agency of your complaint.  CSAR CHVEZ PUBLIC CHARTER SCHOOLS FOR PUBLIC POLICY APPLICATION FOR TEACHING POSITION Please complete and submit this form along with your cover letter, your responses to the Essential Questions, your resume and a copy of your official transcript(s) to  HYPERLINK "mailto:recruitment@chavezschools.org" recruitment@Chvez schools.org. Transcripts may be mailed to the attention of Teacher Recruitment at the Chvez Charter Schools, 709 12th Street, SE, Washington, DC 20003 or scanned and emailed. The application package must be sent by email. Hard copies of application packages will not be accepted. Hard copies of transcripts will be accepted. Candidates will not be advanced until all of the elements of the application package are received. No phone calls please. You may refer to our website  HYPERLINK "http://www.chavezschools.org" www.Chvez schools.org for up-to-date information about the schools and employment opportunities and application materials. If your application is selected for consideration, we will contact you to arrange a phone interview (with either a Vice Principal or appropriate Department Head). Those selected to continue to the next step will then be invited to visit Chvez, interview with two or more school staff members, and teach a demonstration lesson. Upon offer and acceptance of a position, you must submit to a FBI background check. Name:First Middle LastAddress:Street Apt. #City State ZipDay Phone #:Cell Phone #:Fax #:Email: Teaching position desired:Subject Area:Grade(s):Subject Area:Grade(s):Number of years teaching:What date are you available to begin work? Are you able to provide proof that you are authorized to working the US? , Yes , NoHave you been convicted of any law violations other than minor traffic offenses?, Yes , NoIf yes, please explain: Federal Requirements:According to the Federal No Child Left Behind Act, all teachers must be  highly qualified * in the subject area that they teach. Do you meet the DC No Child Left Behind Standards (NCLB) or other highly-regarded state standards in your content area?, Yes , NoPlease indicate with a check mark below any and all definitions of highly qualified that you meet: I have a college degree in the subject area:(please circle) BA MA PhD from:Coursework equivalent to an undergraduate major in the subject area (minimum 33 hours/college credits, 18 upper level).# of credits:Credits from: Advanced certification or credentialing in subject areaPraxis II in subject areaNone* There are a few non-core subject areas that are exempt from these requirements. You can learn more at www.ed.gov. EDUCATION Beginning with high school, provide information on all schools attended including colleges, special courses, and trade schools. Name and Location of SchoolDid you Graduate?Name of Degree or CertificateMajor/Minor  , Yes , No  , Yes , No  , Yes , No EMPLOYMENT EXPERIENCE Please list your current and past jobs, starting with your present or most recent job. Include any military experience. A resume does not take the place of this form. May we contact your present employer? , Yes , No Company Name Telephone ( )Dates Employed From: To:Address # of Hours Worked per Week:Job Title Name of SupervisorHourly Rate/Salary Start: Last:Describe duties: Reason for Leaving: Company Name Telephone ( )Dates Employed From: To:Address # of Hours Worked per Week:Job Title Name of SupervisorHourly Rate/Salary Start: Last:Describe duties: Reason for Leaving:Company Name Telephone ( )Dates Employed From: To:Address # of Hours Worked per Week:Job Title Name of SupervisorHourly Rate/Salary Start: Last:Describe duties: Reason for Leaving:Company Name Telephone ( )Dates Employed From: To:Address # of Hours Worked per Week:Job Title Name of SupervisorHourly Rate/Salary Start: Last:Describe duties: Reason for Leaving:Company Name Telephone ( )Dates Employed From: To:Address # of Hours Worked per Week:Job Title Name of SupervisorHourly Rate/Salary Start: Last:Describe duties: Reason for Leaving:References: List threeMay we contact these references? , Yes , NoEmployer:Contact Person:  Contact s Phone #:NameTitle Contact s Email:Employer:Contact Person:  Contact s Phone #:NameTitle Contact s Email:Employer:Contact Person:  Contact s Phone #:NameTitle Contact s Email: Have you worked in a Chvez school in the past?, Yes , NoIf yes, when and in what capacity?How did you learn about Chvez and the position you are seeking? Cover Letter Please be sure to respond to the following questions in your cover letter: Why do you want to teach at Chvez ? What special skills, interests, or qualifications make you a strong candidate for employment at Chvez ? What is your past teaching experience?  YOU MUST SIGN THIS APPLICATION. READ THE FOLLOWING CAREFULLY BEFORE YOU SIGN. If offered a position by Csar Chvez Public Charter Schools, I agree to provide a Federal background check authorization to Chvez understanding that my employment is contingent upon its successful completion. I understand I need to submit original transcripts of my education and proof that I fulfill the requirements of No Child Left Behind with regard to subject matter expertise. I further understand that my employment is contingent upon my ability to demonstrate my right to work in the United States by successfully completing the Employment Eligibility Verification Form (I-9). I certify that all answers given herein are true and complete to the best of my knowledge. I authorize any reference checks as well as the investigation of all statements contained in this application for employment that may be necessary in arriving at an employment decision (this process includes background checks). In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. If selected for employment, I further understand that my employment is contingent upon passing a background investigation and that I may be asked to submit to an employment physical and random drug testing. I also understand that, if hired, I will be required to abide by all rules and regulations of the Csar Chvez Public Charter Schools for Public Policy. ________________________________________ __________________________ Applicants Signature Date Nondiscrimination & Compliance Statement The Csar Chvez Schools are an equal opportunity education institution and will not on the basis of race, color, national origin, gender, sexual orientation, age, disability or any other capacity protected by law discriminate in its admission to or employment in its educational programs or activities as required by Title II of the ADA, Title VI, Title IX, and Section 504. If you believe you have been discriminated against for these reasons on consideration of your application, please notify Mitzi Burby, Title IX Coordinator of the Chvez Schools at 709 12th Street, SE, Washington, DC 10003, phone: 202.547.3975; fax: 202.547.3449; email: mitzi.burby@Chvez schools.org. 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