EmailMe Form - Heritage Employment Application

Date of Application

MM / DD / YYYY

Are you a U.S. citizen or national, permanent resident, temporary resident, legalization applicant, refugee or asylee?

Yes

No

The Immigration Reform and Control Act of 1986 prohibits the employment of unauthorized aliens, and requires employers to verify the employment eligibility of all new employees. An offer of employment made by Heritage will be conditioned upon your providing the documentation required by law as evidence of your personal identity and your authorization to work in the United States. Any offer of employment is also conditioned upon the successful completion of a background investigation, a post-offer physical evaluation (if applicable), and a drug screen.

Temporary residence does not include those with non-immigrant work authorization (F.J.H or L visas). A legalization applicant is one who is eligible and who has made a naturalization application within the regulatory time requirements of the INS. Exceptions to these requirements may be considered by the Board of Directors of the School, in their sole discretion, based on individual facts and circumstances.

Personal Data

Name

First Last

Previous/Different last name(s) used in past 7 years (please indicate N/A if you have no other names)

Please skip a line between name entries.

Current Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email Address

Phone (day)

### - ### - ####

Phone (evening)

### - ### - ####

Social Security Number (no dashes)

This is a secure form through emailmeform.com

Date of Birth

MM / DD / YYYY

Job Interest

Position(s) Desired

Date Available for Employment

MM / DD / YYYY

How or by whom were you referred to us?

Education and Training

High School Name, City, State

Did you graduate from high school?

Yes

No

GED

Trade School Name, City, State

Did you graduate from trade school?

Yes

No

N/A

Trade Studied

College Name, City, State (1)

Did you graduate from this college (1)?

Yes

No

N/A

Degree and Major (1)

Cumulative GPA (1)

College Name, City, State (2)

Did you graduate from this college (2)?

Yes

No

N/A

Degree and Major (2)

Cumulative GPA (2)

Please indicate the name(s) you used during your highest level of education

Prior Address Information

Please indicate all addresses – other than the current address indicated earlier – that you have used in the last seven years.

Prior Address 1

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Address 1 from...

MM / DD / YYYY

Date you began living at prior address 1

Address 1 through

MM / DD / YYYY

Date you moved from prior address 1

Prior Address 2

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Address 2 from...

MM / DD / YYYY

Date you began living at prior address 2

Address 2 through

MM / DD / YYYY

Date you moved from prior address 2

Employment

Were you ever previously employed by Heritage?

Yes

No

If yes, dates employed with Heritage: From...

MM / DD / YYYY

...through (previous Heritage employment)

MM / DD / YYYY

Previous Heritage employment position

Employment Record

Starting with your current or most recent employment, list all previous employers. Include self-employment, military service, summer, and part-time jobs for at least the last ten years. Must be completed in full for each employer. Writing “see resume” is not acceptable.

Organization Name (1)

Organization Address (1)

Street Address City State / Province / Region Postal / Zip Code Country / Region

Start Date (1)

MM / DD / YYYY

End Date (1)

MM / DD / YYYY

Job Title and Duties (1)

Department (1)

Salary (1)

When may we contact employer (1)?

Now

After acceptance of offer

Reason for Leaving (1)

Name and Title of Supervisor (1)

Organization Name (2)

Organization Address (2)

Street Address City State / Province / Region Postal / Zip Code Country / Region

Start Date (2)

MM / DD / YYYY

Start Date (2)

MM / DD / YYYY

Job Title and Duties (2)

Department (2)

Salary (2)

When may we contact employer (2)?

Now

After acceptance of offer

Reason for Leaving (2)

Name and Title of Supervisor (2)

Do you have any relatives currently employed by Heritage or on the Board of Directors?

Yes

No

If yes, name of relative employed by Heritage or on the Board of Directors

Are you a current Heritage Parent?

Yes

No

If yes, list student(s) name and grade

Why do you desire to make a change from your present position?

Please articulate your testimony or personal story of grace? In other words, please explain how you came into a personal relationship with Jesus?

Do you attend church regularly?

Yes

No

If yes, what church do you attend, how long have you attended, and what is the denomination or affiliation?

Are you a member at that church?

Yes

No

Please provide the name and phone # of your pastor or other church leader whom we may contact.

Name one person in whose life you have had some spiritual input, and briefly describe your relationship.

Lifestyles

Answering “Yes” to the questions below will not automatically disqualify you from employment at Heritage. As a biblically based educational institution, however, we must assure that the principles and values of our employees are consistent with our Christian philosophy.

Have you ever been divorced?

Please answer "yes" or "no" and if yes, please give reason

Do you consume alcohol?

Yes

No

If yes, how often do you consume alcohol?

Do you tobacco products?

Yes

No

If yes, how often do you use tobacco products?

What is your attitude toward matters of recreation and entertainment which some Christians practice and other Christians do not?

Honors and Achievements

Please list relevant academic and athletic honors, extracurricular activities, and offices held.

Interests

Please discuss your travel experiences.

What periodicals do you read regularly?

Of the books you have read recently, which do you most esteem?

What school activities could you coach, sponsor, or assist?

Additional References

Besides your pastor and current or past supervisor, please list at least SIX other people we may contact with reference to your application. Include teaching peers if applicable.

Please include a name, their title/relationship, and a daytime phone number. Please enter one reference per line

Convictions/Suspensions/Debarments

Have you ever been convicted of a felony? Include all pleas of “guilty” or “no contest.”

Yes

No

Have you been convicted of or imprisoned for any type of misdemeanor within the last seven years?

Yes

No

Are you currently suspended or otherwise ineligible to work in any profession, has any license or certificate you have held been revoked, or have you been subject to any formal disciplinary action by an employer, government agency or other overseeing body?

Yes

No

If Yes to any of the above questions, please explain fully.

This information will not necessarily bar an applicant from employment and, therefore, any uncertainty should be resolved in favor of disclosure. The nature and seriousness of the crime and date of conviction will be considered.

Teaching Applicants

PLEASE COMPLETE THIS SECTION ONLY IF YOU ARE APPYING FOR A TEACHING POSITION.

Do you have a state teaching certificate?

Yes

No

If yes, from what state is your certificate?

Is your teaching certificate current?

Yes

No

I don't have a certificate

Have you completed any formal Bible or Bible-related courses at or above the Bachelor’s degree level? Please describe:

Have you completed any other types of Bible training or courses outside formal college course work (i.e. Bible Study Fellowship, Correspondence, Church-sponsored classes, etc.)?
If yes, please list course, date, and location:

How many years of FULL TIME formal teaching experience do you have in a traditional school setting?

How many years of PART TIME formal teaching experience do you have in a traditional school setting?

In what types of special education settings have you taught (include classroom, resource/pull out, title 9, reading mastery, self-contained, emotionally disturbed/alternative school, co-op schools, moderate to profound, autism ABA classroom etc.).

Include years full time, years part time, and the type of setting

What grades and subjects are you qualified to teach?

What grades and subjects would you prefer to teach and why?

What types of learning differences do you feel you are most equipped to serve?

Describe your experience with children other than in a school setting.

Please comment on the Lord’s leading in your life toward teaching in a Christian school.

State your Philosophy of Christian Education.

How would you integrate your Christian faith into your teaching and subject matter?

Describe your beliefs about how education for the learning disabled should or shouldn’t differ from a traditional classroom setting? What do you believe children with learning challenges need most?

As a teacher in a Christian school, what is your philosophy in dealing with student-discipline issues?

Support Staff Applicants

PLEASE COMPLETE THIS SECTION ONLY IF YOU ARE APPLYING FOR AN ADMINISTRATIVE, MAINTENANCE, OR SUBSTITUTE TEACHING POSITION.

Administrative Applicants

Rate your ability level for each of the following:
1=No knowledge 2=Basic knowledge 3=Personally proficient 4-Proficient, able to train others

Apple Computer General

No Knowledge

1

2

3

4

Proficient, able to train others

Mac OS X

No Knowledge

1

2

3

4

Proficient, able to train others

iCloud

No Knowledge

1

2

3

4

Proficient, able to train others

iMail

No Knowledge

1

2

3

4

Proficient, able to train others

iTunes

No Knowledge

1

2

3

4

Proficient, able to train others

iPhones/iPads

No Knowledge

1

2

3

4

Proficient, able to train others

MS Word

No Knowledge

1

2

3

4

Proficient, able to train others

MS Excel

No Knowledge

1

2

3

4

Proficient, able to train others

MS Powerpoint

No Knowledge

1

2

3

4

Proficient, able to train others

Web Maintenance

No Knowledge

1

2

3

4

Proficient, able to train others

Photoshop

No Knowledge

1

2

3

4

Proficient, able to train others

Electronic File Organization

No Knowledge

1

2

3

4

Proficient, able to train others

Electronic Enrollment Tracking

No Knowledge

1

2

3

4

Proficient, able to train others

VoIP Phone System Maintenance

No Knowledge

1

2

3

4

Proficient, able to train others

Library Systems

No Knowledge

1

2

3

4

Proficient, able to train others

Other software experience

Other clerical skills

Typing Speed (wpm)

Other education or course work related to this field

Maintenance Applicants

Please indicate the amount and level of experience you have in the following areas

HVAC repairs

Electrical repairs

Plumbing repairs

Wallpaper

Small engine repairs

Irrigation repairs

Welding

Carpentry

Sheetrock repair

Auto repair

Roofing repair

Floor/carpet care

Other relevant maintenance skills

What power tools have you operated?

What heavy equipment can you operate?

Other education or course work related to this field

Substitute Teacher Applicants

I would substitute/substitute teach in the following: (please check all that apply)

Office

Classroom

Check any that apply

Days available

I would prefer to substitute in

I would prefer NOT to teach a class, but only monitor or administer quizzes, tests, etc.

True

Leave blank if you would also like to teach

I would like to monitor, but am also prepared to teach in the following grade levels/subject areas

Multiple selections allowed

All Applicants

Mission Statement

Heritage School provides a challenging and Christian education to students of average to above average ability, who have learning differences. The school joyfully engages students’ hearts and minds within a framework of a Christ-centered classical education that embodies the ideas of Charlotte Mason.

Vision Statement

Heritage School provides a robust academic curriculum that challenges students to achieve their full potential. Through an individualized approach that remediates a child’s weaknesses and builds on his strengths, Heritage aims to return students to the mainstream academic environment as quickly as possible, equipped to be confident and capable students.

Our goal is to honor each family's time by enabling students to receive some of their needed therapy during regular school hours. Recognizing that each student has unique goals, Heritage works in concert with a variety of specialists. Heritage serves students with learning differences that include reading disorder (dyslexia), auditory processing disorder, oral and written language disorder, speech and language deficits, ADHD, and mathematical disability.

Doctrinal Statement

1) We believe that the Scriptures are the very Word of God in their entirety and, therefore, are our authority in matters of faith and practice.

2) We believe in one God, creator of the universe, eternally existing in the persons of the Father, the Son, and the Holy Spirit.

3) We believe that God created man in His own image, and when man disobeyed God, he fell from grace and brought sin into the world.

4) We believe that Jesus Christ was conceived by the Holy Spirit, born of the Virgin Mary, crucified for our sin, and raised from the dead in eternal victory. He is undiminished deity and genuine humanity in one person.

5) We believe that the Holy Spirit is a personal Being who convicts the world of sin and who regenerates, indwells, empowers, guides, and seals believers eternally for God.

6) We believe that regeneration by the Holy Spirit is absolutely necessary for the salvation of lost sinners, and that those who receive the Lord Jesus Christ by faith are born again into the family of God.

7) We believe that the family of God is the church, which is the body of believers of which Christ is the head.

8) We believe that Heaven is the abode of God and the place of eternal joy for the saved, and that Hell is the place of eternal punishment of separation from God for the lost.

I have read and am in full agreement with Heritage’s mission and vision statements.

Yes

No

I have read and am in full agreement with Heritage’s doctrinal statement

Yes

No

If you answered “No” to either of the above, please discuss this area(s) of disagreement or the area(s) in which you may not yet have formed an opinion. (Use additional sheet if needed.)

Privacy Policy

At Heritage, we are committed to protecting your privacy. Your personal information may be maintained in an electronic database in the U.S. and will be processed by a third party provider for purposes of conducting background investigations. Your personal information will be used by Heritage for recruitment and background check purposes. It will be protected from the loss, misuse, unauthorized access or disclosure, alteration, or destruction of the information under our control. By submitting your personal information and signing this application, you agree that Heritage may process it for recruitment, human resources processes, and background check purposes.

Applicant Release and Acknowledgement

I understand that Heritage School of Texas (hereinafter referred to as Heritage) requires certain information about me to evaluate my qualifications for employment and to conduct its business if I become an employees. Therefore, I authorize Heritage to conduct all required background checks, investigate my past employment, educational credentials, and other employment-related activities. I agree to cooperate in such investigations and release those parties supplying such information to Heritage of responsibility with respect to information supplied.

I agree that Heritage may use the information it obtains concerning me in the conduct of its business. I understand that such use may include disclosure outside of Heritage in those cases where its agents and contractors need such information to perform their functions, where their company’s legal interests and or obligations are involved, or where there is a medical emergency involving me. I understand, however, that Heritage intends to protect the confidentiality of personal information it obtains concerning me to the extent required by law.

I agree that I will not disclose or use while interviewing with or employed with Heritage any confidential or proprietary information of others, including any former employer.

I understand that any employment with Heritage would not be for any fixed period of time and that, if employed, I may resign at any time, for any reason, or the School may terminate my employment at any time for any reason in the absence of a specific written agreement to the contrary, signed by Heritage. I understand that my employment-at-will status may not be modified or changed except in writing and signed by a duly authorized officer of Heritage.

I understand that any false answers or statements made by me on this application, any supplement thereto, or in connection with the above-mentioned investigations may be grounds for refusal of employment, invalidate my employment or, if employed, will be sufficient grounds for immediate discharge and render me ineligible for any benefits.

All applications and supporting materials for employment at Heritage once submitted, become the property of Heritage.

My name below acknowledges that I have read, understand, and agree to the terms of the entire application.

Date acknowledged

MM / DD / YYYY

Attach a copy of W-4 form (full time)

W-4 form can be found at this IRS link

Attach a copy of W-9 form (part time)

W-9 form can be found at this IRS link

Attach a copy of Social Security card

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Attach a copy of your driver license

Attach a copy of a voided check

Attach a copy of official transcripts

Attach a copy of your résumé

Attach a copy of your teaching certificate

Signature *

Clear