Vista Academies

PERSONAL INFORMATION

Date of Application:

Date Available for Employment:

- -

Part Time

Full Time

Position Applying for

Name

Last Name

First Name

Middle Name

Address

Street

City

State

Zip

Telephone

Are you related to a member of RES's Board

Yes No

How did you hear about us?

What campus are you interested in?

EDUCATIONAL BACKGROUND
Name of Institution	City & State	Major Field of Study	Minor Field of Study	Degree/Hrs. Earned
High School
College/University


STUDENT TEACHING/PROFESSIONAL EXPERIENCE
School District & Campus	Grade/Subject	Dates Taught From-To	Supervisor/Principal	Reason for Leaving


Total Years of Teaching Experience:


CERTIFICATE & LICENSE INFORMATION
Type of Certificate/License (Attach a copy)	Areas of Specialization	Dates Issued	Expiration Date	State


OTHER WORK EXPERIENCE
Company	Address and Phone	Job Title & Salary	Dates Employed From-To	Supervisor	Reason for Leaving


PROFESSIONAL INFORMATION
Publications/Articles:
Professional Organizations:
Seminars/Workshops Conducted:

GENERAL INFORMATION
Current monthly salary:
Salary needed to work in a Responsive Education Solutions LearningCenter:
Have you ever been (1) arrested (2)convicted of, or (3) pled guilty, or (4) pled no contest (nolo contender) to a felony or misdemeanor other than a minor traffic violation?	Yes No
If YES, please explain:

Have you ever been asked to resign or been terminated through due process from any position?	Yes No
If YES, please explain:


REFERENCES
Please list two work related references and three personal references that may be contacted regarding character and work history.
Name	Position/Relationship	School District/Company	Area Code & Telephone#


PERSOANL STATEMENT
Please make a statement concerning your reasons for desiring a position with the Responsive Education Solutions. Give additional information about your background, training, experience, and future plans that would be pertinent to your application (use additional sheets of paper if necessary).

ACKNOWLEDGEMENTS:

I understand that the position for which I am applying is considered at-will, which means either Responsive Education Solutions, or I can terminate employment for any reason or no reason at any time.

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge. I understand that, if employed, any falsified information may be considered sufficient cause for dismissal. Responsive Education Solutions is authorized to make an investigation of my education and work history and may contact the references listed.

I Agree

Responsive Education Solutions is an equal opportunity employer and does not discriminate on any basis prohibited or protected by federal or state law including race, color, disability, sex, religion, age, or national origin.