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APPLICATION FOR EMPLOYMENT
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Franklin
Academy
106 River Road, East Haddam, Connecticut 06423 Phone: (860) 873-2700 Fax: (860) 873-8861 Website: www.fa-ct.org |
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| Name: (Last) _________________________(First) ________________________ (M.I.) ______________________ | ||||||
| Address: ____________________________________________________________________________________ | ||||||
| Phone: ___________________ Email: ____________________________ SS #: ____________________________ | ||||||
| Drivers License #: ___________________________ State Issued: ______ Class: __________________________ | ||||||
| Position Applying For: __________________________________________________________________________ | ||||||
| Applications are considered to be complete when the following information has been received: | ||||||
| 1. A completed
application form; 2. A cover letter; 3. A current resume; 4. Copies of undergraduate and graduate transcripts. |
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| EDUCATION: | ||||||
| Name of College/University and Location |
Dates Attended
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Degree
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Area of Concentration | |||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| EMPLOYMENT (Starting with most recent): | ||||||
| School, Company, Organization and Location |
Dates of
Employment |
Position, Subjects, Extracurriculars | ||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| CERTIFICATION (Please note that certification is not a prerequisite for a position at Franklin Academy): | ||||||
| Status of Certification: _________ Current _________ Pending | ||||||
| Indicate what type of certificate(s) you hold or is pending and in what subject(s) or area(s) you hold it in: | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| State that issued your certification: _____________ Expiration Date: ______________________________________ | ||||||
| THREE CHARACTER REFERENCES: | ||||||
| Name and Position | Address and Phone Number | Number of Years Known | ||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| Connecticut
State Law provides authorization to conduct criminal background checks of
all employees. If Franklin Academy receives notice of a conviction of a crime that has not been disclosed below, the school may immediately dismiss you. |
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| Have you ever been convicted of a felony, any other criminal offense, or traffic violation (not a parking ticket)? | ||||||
| _______ Yes _______ No | ||||||
| If yes, identify the approximate date, location, and nature of each such conviction: | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| ________________________________________________________________________________ | ||||||
| I hereby certify
that there are no misrepresentations, omissions, or falsifications in the
statements and answers provided on this application, and that the answers are true, complete, and accurate to the best of my knowledge |
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| I authorize Franklin
Academy to contact any of the educators, employers, and references listed
on this application. I further authorize such educators, employers, and references to release to Franklin Academy any and all information (including documents and/or other records) regarding my education, employment history, or any other matter related to my application for employment with Franklin Academy. |
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| Signature: ____________________________________________ Date: ___________________________________ | ||||||
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Franklin Academy is an Equal Opportunity Employer and
does not discriminate on the basis of
race, religion, gender, sexual orientation or national origin. |
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