Staff Application

Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Gender*
Marital Status*
Spouse Name
First Last

Education
Post Secondary Education
Name of Institution Degree/Diploma Major Graduation Date
Do you currently hold a valid FL State Teaching Certificate?*
Certifications (Past and Present)
Type Number Expiration Date
Have you ever had your teaching certificate suspended or revoked?*

Work Experience
Last Employer
Name of Employer Position Held Dates of Employment Boss Name Employer Phone Number (include extension if applicable)

List the name of your last place of employment, the position you held, your dates of employment, your boss's name, and your employer's phone number.
Classroom Experience
School Name / Homeschool Position Course Taught Grade Level Date

List all homeschool and classroom teaching experiences, beginning with the most current.
Other Experience
Company Position Job Description Date

Background Information
Have you ever been charged with or convicted of a crime against a child under the age of 18?*
If you answer is "yes", please explain.
Are you willing to undergo VECHS fingerprinting, as required by FL law, at your own expense, if you are hired by Wellmont Academy?*
Have you ever been charged with or convicted of a crime not involving a child?*
If your answer is "yes", please explain.

Personal Focus
What do you perceive to be your greatest strength?*
What do you perceive to be your greatest weakness?*
What do you believe you can offer Wellmont Academy as a staff member?*
What are your interests or hobbies?*
Do you believe the theory of evolution as described by Charles Darwin to be accurate?*
If you feel the need to quantify this statement, please explain.
Explain how you believe the world was created and approximately how long ago this could have occured.*
Technical Abilities
Are you familiar with Google Docs and Excel Spreadsheets?*
Do you text?*
Do you currently use Facebook?*
Do you feel reasonably confident that you would be able to learn to use a website interface similar to Facebook as a tool for communicating with parents, students and staff, and creating tests and materials online (with training)?*

Spiritual Life
Are you a born-again Christian?*
How long have you been saved?*
If you answered "yes", please explain what the Gospel of Jesus Christ means to you personally.
Are you a current member of a church?*
If your answer is "yes", please list the name of the your church.
How long have you been a member?
What is your pastor/home fellowship leader's name?
Pastor/home fellowship leader's phone number
Pastor/home fellowship leader's email
Phone
This field is for validation purposes and should be left unchanged.

Name of Employer	Position Held	Dates of Employment	Boss Name	Employer Phone Number (include extension if applicable)

School Name / Homeschool	Position	Course Taught	Grade Level	Date

Name of Institution	Degree/Diploma	Major	Graduation Date

Type	Number	Expiration Date

Company	Position	Job Description	Date

Personal Information