AESS_TEACHER_APPLICATION

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					               ACADEMIC ENRICHMENT SERVICES & SYSTEMS (AESS)
                         P. O. Box 52295      Durham, N. C. 27717
                         708 S. Duke Street   Durham, N. C. 27701
                      Phone: 919 688 AESS (2377)   Fax: 919 688 2373

                                        Employment Application
                Please complete all questions on this application, incomplete application will be discarded.



                                                 PERSONAL DATA
Last Name                                       First Name                                    Middle Name


Maiden Name (if applicable)                     Social Security Number                        Date of Birth (M/D/Y)


Street Address                                  City                                          State         Zip Code

E-Mail Address           Alternate E-Mail          Home Number             Cell Number            Work Number
                         Address
Previous Addresses (including city/state/zip) if you have lived at current address less than 2 years)


Position for which you are       Date/days/times available to     Have you ever been convicted of a crime? Yes No
applying:                        work:                            You are required to attach a certified criminal report.



                                       ACADEMIC QUALIFICATIONS

           High School Graduate                 YES      NO                         GED               YES       NO
                                       (Circle one)                                          (Circle one)
Name of High School/GED                    Street Address                          City                        State
Institution


       List Educational Institutions Beginning With the Highest Degree Earned:
       Date                                                                                  Number Hours       Major &
      Fr/To-            Name of Institution            Address (Street/City/State/Zip)        Completed         Degree
       M/Yr
Fr:

To:

Fr:

To:

Fr:

To:

List Teaching Certification and/or licenses (include state certified, active or expired:
_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________



Initial _____________
                                       EMPLOYMENT HISTORY

                   Please list your employment for the last ten years:
Employer’s Name:                              Employer’s address (Street/City/State/Zip)


Position:              Supervisor’s Name                            E-Mail address:        Phone Number:


Dates:                 Duties/Responsibilities:
Fr:

To:

If Part Time, Number
of hours:              Can we contact your supervisor:              Reason for leaving:


Employer’s Name:                              Employer’s address (Street/City/State/Zip)


Position:              Supervisor’s Name                            E-Mail address:        Phone Number:


Dates:                 Duties/Responsibilities:
Fr:

To:

If Part Time, Number
of hours:              Can we contact your supervisor:              Reason for leaving:


Employer’s Name:                              Employer’s address (Street/City/State/Zip)


Position:              Supervisor’s Name                            E-Mail address:        Phone Number:


Dates:                 Duties/Responsibilities:
Fr:

To:

If Part Time, Number
of hours:              Can we contact your supervisor:              Reason for leaving:

Employer’s Name:                              Employer’s address (Street/City/State/Zip)


Position:              Supervisor’s Name                            E-Mail address:        Phone Number:


Dates:                 Duties/Responsibilities:
Fr:

To:

If Part Time, Number
of hours:              Can we contact your supervisor:              Reason for leaving:



Initial _____________
          Please use complete sentences to answer the questions listed below:

Please describe your teaching or tutoring experiences (if applicable). Attach an
additional sheet if necessary.




In which subject and at what grade levels are you qualified to teach or tutor?




Please list your Language Proficiency: (skills other than English, the level, [speak,
read, write, etc.])




                                      PROFESSIONAL REFERENCES
  Please list three professional references. Please make sure that contact information accurate. References must be completed
                                                           before hiring.

 Name                                                                         Title (if applicable)

 Street Address                                          City                                     State          Zip

 E-Mail Address             Home Number                  Cell Number                 Work Number              Are you related:
                                                                                                              Yes No , if yes
                                                                                                              Relationship:

 Name                                                                         Title (if applicable)

 Street Address                                          City                                     State          Zip


 E-Mail Address             Home Number                  Cell Number                 Work Number              Are you related:
                                                                                                              Yes No, if yes
                                                                                                              Relationship:

 Name                                                                         Title (if applicable)

 Street Address                                          City                                     State          Zip

 E-Mail Address             Home Number                  Cell Number                 Work Number              Are you related:
                                                                                                              Yes No , if yes
                                                                                                              Relationship:



Initial _____________
Before considering you for a position, AESS requires that you read and accept the following
statements. If you do not agree, do not submit the application.
Terms of Employment
I understand and agree that AESS acceptance of this application does not mean that a
position for which I am applying and/or qualified is open, that AESS has not agreed to hire me
or is under any obligation to hire me.
I understand and agree that if I am employed or hired I will be hired as an “at will”
independent contractor and may be terminate at any time, with or without cause and with or
without notice.

Authorization for Investigations
I authorize AESS and its agents to investigate all information and references contained in
this application and release all parties from any liability concerning such investigations. These
investigations will include criminal background, education, references and other
background checks as required by the local school district. I also authorize former
employers and references listed on this application to provide information that may be sought
regarding my work habits, character and ability and any other information requested.

Complete and Accurate Information
I hereby certify that the information in this application is true and correct to the best of my
knowledge and that I have not knowingly withheld any information that might adversely affect
my chances to be hired. I further certify that I have personally completed this application.
I understand that any omission or misstatement of material fact on this application, or any
other document used to secure employment, shall be grounds for rejection of this application or
for immediate dismissal if I am employed or hired as a contractor, regardless of the time
elapsed before discovery.

I have read and understand the above statements and by submitting this
application I agree to be bound by them if hired by AESS.


____________________________________                                ____________________
Signature                                                           Date


____________________________________                                ____________________
Principal‘s Signature (when required)                               Date

AESS is an Equal Opportunity Employer. All applicants are considered equally without regard to
race, ethnicity, national origin, sex, religion, age, marital status, disability or veteran status.

Thank you for your interest in working with AESS. Please return your application to AESS, P. O.
Box 52295, Durham, N.C. 27701.

       FOR INTERNAL USE ONLY                                 1                        2
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