Employment Application (Please Print)

Date____________________ Full Name___________________________________SS#_______________________________ Current Mailing Address___________________________________Phone__________________ Cell Phone_______________________________Email_________________________________ U.S. Citizen? Yes_____ No_____ If no, explain_______________________________________ Do you have a valid Driver’s License? Yes______________ No __________________________ Issuing State: _______________Number: ________________Expiration Date:______________ Have you ever been convicted or entered a plea of no contest to a felony or misdemeanor other than a minor traffic violation? Yes _______ No _______ If “yes, “a description of the crime and particulars of the conviction must be submitted. Do you have a current teaching certificate? Yes_______ No _______ Issuing State: _______ Date Certificate Issued: _______ Expiration Date: _______ Areas of Certification: ___________________________________________________________ What extra-curricular activities can you direct? ______________________________________________________________________________ Glenwood School is an equal opportunity employer.

Page 2 SCHOLASTIC PREPARATION: Please enclose transcript(s) or arrange for college/university to send. College/University

Dates Attended

Degree

Major

Minor

TEACHING EXPERIENCE: Please start with your most recent teaching experience. Dates of Employment

Name, Address, and Phone Number of School

Subject(s)/Grade(s) Reason for Leaving Taught

PROFESSIONAL REFERENCES: Please have each reference you list complete one of the enclosed Reference forms and then send the form directly to Glenwood.

Name

Position

Address

Phone

I attest that the information I have provided on this application is accurate and true. I hereby give Glenwood permission to verify the information contained in this application and waive the right to see the evaluations that my references complete and send to the School. Signed: _________________________________________Date:_____________________________

REFERENCE GLENWOOD SCHOOL 5801 Summerville Road Smiths Station, AL 36877 (334) 297-3614 To The Applicant: Please complete the applicant section and direct this form to an individual listed on your application as a reference. Ask that the form be returned to you in the envelope provided which must remain sealed until received at Glenwood School. Applicant’s Full Name & Address: ___________________________________________________ ________________________________________________________________________________ Position Being Applied For:__________________________________________________________ Person Completing Reference Form:____________________________________________________ Please respond to each of the areas for which you have knowledge. Give your candid opinion of the individual’s qualifications for the indicated position.

Excellent 1. Character 2. Personality 3. Enthusiasm for teaching 4. Dependability 5. Tact 6. Initiative 7. Oral communication skills 8. Written communication skills 9. Decision-making skills 10. Promptness 11. Interaction with students 12. Interaction with co-workers 13. Level of professional growth 14. Loyalty and co-operation 15. Management of instructional time 16. Management of student behavior 17. Willingness to accept constructive criticism

Above Average Below Poor Average Average

How long and in what capacity have you known the applicant:_______________________________ _________________________________________________________________________________ If it were your personal decision, would you recommend employment of the applicant? __________ If no, please explain: _______________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Other comments:___________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

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Signature

Date

Name (Please Print):________________________________________________________________ Position:__________________________________________________________________________ Company/School:__________________________________________________________________ Address:__________________________________________________________________________ Telephone Number:_________________________________________________________________