Advance Baton Rouge Charter School Association

1. Lanier Elementary
   Dalton Elementary Glen Oaks Middle
   Prescott Middle Pointe Coupee Central High School
   

1. Last Name: *
2. First Name: *
3. Maiden Name (if any):
4. Date available for work (if offered): *
5. Cell Phone Number: * - -
6. Home Phone Number: * - -
7. Present street address: *
8. City: * State: * Zip: *
9. Are you a citizen of the United States? * Yes No
10. If no, do you have the legal right to work in this country? Yes No
11. Are there any criminal charges pending against you at this time? If yes, please give details:
13. Email Address: *
14. Have you ever been convicted of a crime? * Yes No

15. If yes, state when, where and the nature of the conviction. Conviction of an offense is not automatic bar to employment. All circumstances will be considered, including the nature of the crime and the lengh of time since conviction.

16. Languages you can : Speak *
    Write *
17. Have you been an employee of ADVANCE Baton Rouge Charter School or any other program in the past? * Yes No
18. If yes, list dates of employment and positions held:

1. School (City and State) Field of Study Course Study and Degree Achieved or # of Credit Hours Completed Date of last attendance or graduation
2. High School :
   
3. Junior College :
   
4. College :
   
5. Graduate School :
   
6. Other :
   
7. May Advance Baton Rouge verify educational information? * Yes No

1. Do you hold a valid Louisiana certificate? * Yes No
2. Type: * --- Choose an Option ---ABCTATTEPPL1PL2Out of StateOther If other, please list:
3. Certificate Number: Expiration date:
4. List all the certification areas:
5. Do you hold certification from another state? * Yes No
6. If yes, where?
7. List other certifications held:
8. Do you hold a National Board of Professional Teaching Standards Certification? * Yes No
9. May Advance Baton Rouge verify your credentials? * Yes No

List employment starting with your most recent position. Explain any gaps in employment history.

1. Dates Position / Superviser Major Duties Reason for leaving
2. from:
   to:
   Name and Address of Employer
   Job Title:
   
   Supervisor Name:
   
   Phone Number:
   
   Wages
   Starting: $
      Ending: $
3. Dates Position / Superviser Major Duties Reason for leaving
4. from:
   to:
   Name and Address of Employer
   Job Title:
   
   Supervisor Name:
   
   Phone Number:
   
   Wages
   Starting: $
      Ending: $
5. Dates Position / Superviser Major Duties Reason for leaving
6. Dates Position / Superviser Major Duties Reason for leaving
7. from:
   to:
   Name and Address of Employer
   Job Title:
   
   Supervisor Name:
   
   Phone Number:
   
   Wages
   Starting: $
      Ending: $
8. Dates Position / Superviser Major Duties Reason for leaving
9. from:
   to:
   Name and Address of Employer
   Job Title:
   
   Supervisor Name:
   
   Phone Number:
   
   Wages
   Starting: $
      Ending: $
10. May Advance Baton Rouge verify your employment? * Yes No

In connection with my application for employment with Advance Baton Rouge Charter Schools, I understand and agree that background inquires may be requested by you or on you behalf that will seek information as to my character, work habits, including oral assessments of my job performance, experiences and abilities, along with reasons for termination of past employment. Furthermore, I understand and agree that you may request information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my driving record, credit history, criminal record, civil matters, previous employment, educational background, and other past experiences.

I acknowledge that a telephonic facsimile or copy of this release shall be as valid as the original. This release is valid for all federal, state, county and local agencies and authorities.

1. Last Name: * First Name: *
2. Middle:
3. Social Security Number:
4. Response to the questions in this section are optional and voluntary, for ID only
5. Date of Birth: Race: Sex: M F
6. Former Names and Time Frames (if applicable):
7. Reference Name / Title Company Name Location Contact Information

1. Please attach your resume

I authorize investigation of all statements in this application, my attached resume, or other attachments. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without previous notice. I hereby give Advance Baton Rouge Charter School Association (ABRCSA) permission to contact schools, previous employers (unless otherwise indicated), references and others. I further authorize the company complete a criminal background check. I hereby release ABRCSA from any liability as a result of such contacts, inquires or records in order to ascertain my qualifications and fitness for employment.

I understand that this application for employment is not a contract and is not intended to confer or create contractual rights of any kind or nature. If employed, employment is on an at‐will basis and may be terminated at any time and for any reason with or without cause, by either the employee or ABRCSA.

I understand that in accordance with the Immigration Reform and Control Act of 1986 that I will need to provide ABRCSA with appropriate documentation certifying my identity and eligibility to work within the United States. I understand that I will need to provide this documentation in order to be employed.

1. Type Name Here * Type "I Understand" Here*