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GENESIS INNOVATION ACADEMY

2017-2018 APPLICATION FOR EMPLOYMENT

Before Completing Form - Please Note

This application form is intended for use in evaluating your qualifications for employment. Please answer all questions completely and accurately. False or misleading statements on this form or during an interview may result in the termination of the application process or, if discovered after employment, terminating employment. A resume and a personal statement (in a single document) should be submitted for all positions along with your application.

Position Applying For:

Please select school area: (*)
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Please select job(s) you are applying for:(*)

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Please select job(s) you are applying for:(*)

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Please select job(s) you are applying for:(*)

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Personal Information


Name:

First Name (*)
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Last Name (*)
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Contact Information:

Primary Phone Number(*)
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Alternate Phone Number
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Email(*)
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Certification


NOTE: Certification is not required for all positions at Genesis Innovation Academy.

Georgia Certification (*)
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Certification from Outside GA?(*)
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Have you taken and passed any Georgia Assessment for Certification of Educators (GACE) exams?(*)
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Gifted Endorsement?
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ESOL Endorsement?
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Education


List colleges and universities that you have obtained a degree from (or at which you are pursuing a degree). Begin with most recent:

College/University(*)
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Major(*)
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Degree(*)
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Minor/Secondary Field
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College/University
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Major
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Degree
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Minor/Secondary Field
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College/University
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Major
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Degree
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Minor/Secondary Field
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Experience


Years Teaching(*)
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Years of Applicable Non-Teaching Experience
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Please complete this field if you are applying for a non-teaching position.

Indicate the types of schools in which you have taught/worked:

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Indicate level of schooling in which you have taught/worked:

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Please list subjects taught:
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General Information


Were you ever in the armed forces?(*)
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Are you a citizen of the United States?(*)
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Safety and Security Pre-Screen


Answer each question yes or no. You must attach a written explanation if you answered “yes” to any of the questions below.
THIS SECTION MUST BE COMPLETE FOR AN APPLICATION TO BE CONSIDERED.
1. Have you been convicted of or pled nolo contendre on any of the following, including, but not limited to: murder, sexual or physical assault, rape, child molestation, kidnapping, manslaughter, extortion, sexual misconduct with a minor, indecent liberties, incest, unlawful imprisonment, child abuse or neglect, abduction for immoral purposes, failure to secure medical attention for an injured child, pandering, crimes against nature involving children, malicious harassment, patronizing a juvenile prostitute, child abandonment, violation of a child abuse protective order, obscenity offenses, possession or distribution of drugs, arson, use of a firearm in the commission of a felony, child buying or selling, prostitution, felony indecent exposure, larceny, embezzlement or any of these crimes as may be renamed in the future?(*)
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2. Have you been convicted of any felony or misdemeanor other than those listed above in question 1 or pled nolo contendre, or are you now under investigation for any such offense, other than a minor traffic offense? For the purpose of this application DUI/ DWIs must be reported.(*)
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3. Have you ever resigned or been discharged from any position, including the Armed Forces while under suspicion of having engaged in criminal, immoral or unprofessional conduct, or are you now under investigation for any such charge?(*)
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4. Have you ever surrendered your teaching or administrative certificate/license/permit, or had one denied, revoked or suspended or is any investigation or adverse action now pending against you?(*)
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5. Have you ever had any disciplinary action taken against you by a previous employer, including written reprimand, suspension, demotion, non-­renewal, termination or any other form of disciplinary action?(*)
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Please check each of the following:

I have identified that all statements and data provided are true and correct to the best of my knowledge. I agree that falsification will constitute disqualification of my application or dismissal from employment from the Genesis Innovation Academy.(*)
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I understand that any offer of employment is contingent upon Genesis Governing Board approval and an acceptable outcome of criminal records check.(*)
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Electronic Signature

By selecting the "I Accept" button, you are signing this Application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application.(*)
You must check "I Accept" on signature to submit your application

Resume and Personal Statement


Personal Statement Topic: In 500 words or less, please describe your vision of the role for which the application is being submitted.

Upload Your Files

Merge resume, personal statement, and (if required) any explanation of past legal concerns into a single document.
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Accepted file types: pdf, doc, docx, txt    Maximum file size: 24MB