Bilal Academy Employment Application

Applicant Information

Name

Mobile Phone

Mobile Phone Carrier

e.g. Verizon, AT&T, T-Mobile — used for text message alerts.

Age

Email

Home Address

Position Applied For

Position(s) for which you are applying Tick every position you would like to be considered for.

Other position (if not listed above)

Are you applying as paid staff or as a volunteer?

Paid Volunteer

Expected salary

Background

Educational Background

Schools attended, degrees or certifications earned.

Employment History

Experience

Relevant experience working with children or in education.

References

Please give name, relationship and phone number for each reference.

Have you ever been convicted of a violation of law other than a minor traffic violation?

No Yes

If yes, please explain

Have you ever been terminated or discharged, or resigned at the request of your employer, from any job related to K-12 education?

No Yes

If yes, please explain

Regarding your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?

No Yes

If yes, please explain

Are you currently under investigation by any regulatory body for any alleged misconduct or other alleged grounds for discipline?

No Yes

If yes, please explain

Required Disclosures

Authorization

I hereby certify that the statements made by me in this application and all related information which I have provided are true, accurate, and complete to the best of my knowledge. I understand that if I provide any false, inaccurate, or incomplete information, I will not be eligible for employment or volunteer service, or if I am hired, I will be subject to disciplinary action or dismissal regardless of the date on which the academy discovers the violation of its policy regarding application form dishonesty.

I have read and agree to the statement above.

Yes

Signature (type your full name)

Date