Form# 3.2A Page 1 of 5 Revised 8.12.2019 DIOCESE OF GALLUP OFFICE OF CATHOLIC SCHOOLS P. O. BOX 1338 Gallup, New Mexico 87305 Voice: (505) 863-4406 ext. 21, Fax: (505) 863-2269, Email:
[email protected] TEACHER APPLICATION The Diocese of Gallup Office of Catholic Schools considers applicants for all positions without regard to race, color, sex, national origin, age, disability, marital, or veteran status. INSTRUCTIONS: q Please complete this application form and return it to the address given above. Keep a copy for your files. A copy of this application will be forwarded to the locations you identify in this application. q You must fully and accurately complete the Teacher Application form. Incomplete applications will not be considered. Resumes do not substitute for any part of the application. Add additional pages as needed. q All teacher applications are considered inactive after one year. q If you are selected, the following must be submitted BEFORE STARTING WORK: • A clear criminal record from the DOJ and FBI • Proof of citizenship or immigration status to verify your right to work in the U.S. (I-9 form) • A signed copy of the Safe Environment “Code of Ethics” • Official copies of your official transcripts from accredited colleges/universities indicating your BA degree and post-graduate grades/degrees sent directly to the Office of Catholic Schools • If applicable, your official and active teaching credential A. GENERAL APPLICANT INFORMATION Full Name Home Address City, State, Zip Home Phone ( ) Social Security # Email Address Religion Date Available to Start If Applicable, Name of Religious Community Address, City, State, Zip POSITION PREFERENCES Employment Status o Full Time o Part Time o Substitute Grade Levels o K-2 o 3-5 o 6-8 o 9-12 Subject Areas Extracurricular Areas Location of Position (School, City, or County) COMPLETE THE FOLLOWING YES NO After employment, can you submit verification of your legal right to work in the United States? Are you a practicing Roman Catholic or, if not, an active member of the religion indicated above? Do you have knowledge of Catholic doctrine and moral precepts and are you willing to teach in accordance with them? Do you hold a BA or BS degree? Have you previously been employed by the Diocese of Gallup? If YES, when From: / / To: / / Location Form# 3.2A Page 2 of 5 Revised 8.12.2019 YES NO Have you previously been employed by another Catholic Diocese or private/religious school? Have you ever left a teaching position at any time other than the end of the school year, excluding any legally protected leaves? Legally protected leaves include but are not limited to FMLA, Workers Comp., ADA accommodation leave, Pregnancy Disability leave, etc. If YES, describe on a separate sheet of paper. Has your teaching credential ever been suspended or revoked? If YES, describe on a separate sheet of paper. Can you perform the essential functions of the teacher position with or without reasonable accommodation? (Job description available upon request) At your sole discretion, you may attach additional information to explain the circumstances of your above answers. B. WORK HISTORY: List Most Recent Employers First Employer/Company Type of Business Address City, State, Zip Immediate Supervisor (Principal, if a school) Company Phone ( ) Dates of Employment From: / / To: / / Position Title Reason for Leaving May We Contact This Employer For a Reference? o YES o NO If NO, why not? If a Teaching Position, complete the following: Position Status o Full Time o Part Time o Substitute o Student Teacher Grades Taught o K-2 o 3-5 o 6-8 o 9-12 o College Subject Areas Extracurricular Areas Employer/Company Type of Business Address City, State, Zip Immediate Supervisor (Principal, if a school) Company Phone ( ) Dates of Employment From: / / To: / / Position Title Reason for Leaving May We Contact This Employer For a Reference? o YES o NO If NO, why not? If a Teaching Position, complete the following: Position Status o Full Time o Part Time o Substitute o Student Teacher Grades Taught o K-2 o 3-5 o 6-8 o 9-12 o College Subject Areas Extracurricular Areas Form# 3.2A Page 3 of 5 Revised 8.12.2019 Employer/Company Type of Business Address City, State, Zip Immediate Supervisor (Principal, if a school) Company Phone ( ) Dates of Employment From: / / To: / / Position Title Reason for Leaving May We Contact This Employer For a Reference? o YES o NO If NO, why not? If a Teaching Position, complete the following: Position Status o Full Time o Part Time o Substitute o Student Teacher Grades Taught o K-2 o 3-5 o 6-8 o 9-12 o College Subject Areas Extracurricular Areas Attach any other employment information that is relevant to your application for employment as a teacher. C. TEACHING EXPERIENCE AND COURSE WORK Total Years of FULL TIME (75%+) Teaching Experience Number of Graduate Level Semester Units Beyond BS or BA One quarter unit equals 2/3 of a semester unit. D. CREDENTIAL AND CERTIFICATION STATUS Type Expires Subject NM or AZ Credentials Other Credentials Do you possess an active Catechist Certificate? If so, from what diocese/archdiocese? Expiration date? o YES o NO Attach to your application a copy of all your current credentials and/or certificates. If hired, you must provide your official Credential to the school office for copying. E. COLLEGE OR UNIVERSITY EDUCATION Name & Location of Each Accredited Institution Dates of Attendance Degree Earned Major & Minor - - - - - - - - - Attach to your application a copy of all your college or university transcripts. Please black out your date of birth on transcripts submitted before hire. If hired, you will be required to request official transcripts to be sent to the Diocese of Gallup Office of Catholic Schools. Form# 3.2A Page 4 of 5 Revised 8.12.2019 F. REFERENCES: Please list 3 persons* who may be contacted as professional references and who possess first-person knowledge of your character, teaching ability, and scholarship. Name & Title Address City, State, Zip Phone *If you have taught, one of your references must be your last principal. G. LETTERS OF RECOMMENDATION: In addition to the three references given above, please submit the following three letters of recommendation from: (1) your current or last employer (principal if applicable); (2) a professional colleague; and (3) your pastor or minister attesting to your commitment to your faith. H. STATEMENT OF INTENT & RESUME: Please attach to this application your response in essay form to the following question: Why do you want to teach in a Catholic school? You may also attach a copy of your resume (optional). PLEASE READ CAREFULLY AND SIGN I authorize the Bishop of the Roman Catholic Diocese of Gallup, the Diocese of Gallup Office of Catholic Schools, or their designees, hereafter “Diocese” to communicate with persons listed as references, former employers, and any others with whom the Diocese desires to check. I agree to hold such persons harmless with respect to any information they may give about me. If employed, I agree to engage in no outside activity that would involve a material conflict of interest with or could reflect adversely on the Diocese. I understand this decision to rest with the Diocese. I understand that the Diocese may change the terms and conditions of my employment with or without notice. I understand that no representative of the Diocese, other than the Bishop, Superintendent of Catholic Schools, Pastor, Rector, or Board of Trustees has the authority to enter into any contract or employment agreement and then only if the commitment is a signed written agreement. As part of the hiring process there will be background checks for the purposes of safe environment and protection of minors. In consideration of my employment, if I am employed, I agree to conform to the employment policies of the Diocese I understand that the completion of this Teacher Application does not guarantee that I have been or will be employed by the Diocese. I hereby affirm that my answers to these statements and questions are true and correct to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably. I understand that any misrepresentation, deception or false statement made in this application for employment may result in my not being considered for employment, and if not discovered by the Diocese until after my becoming employed, are grounds for, and may result in, my immediate termination. Signed _________________________________________ Date __________________ Form# 3.2A Page 5 of 5 Revised 8.12.2019 ATTACHMENTS TO THIS APPLICATION To consider your application file complete, attach the following items to your application form. Please check off V those items that apply to your application. CREDENTIALS and CERTIFICATES (Recommended) .................................................................. Item D., Page 3 m I have attached a copy of all my current and active teaching credentials. m I do not possess a current teaching credential or certificate at this time. m I have attached a copy of my Catechist Certificate. m I do not possess s Catechist Certificate at this time. COLLEGE/UNIVERSITY TRANSCRIPTS (Minimum Requirement for Eligibility) ........................ Item E., Page 3 m I have attached a copy of all my college/university transcripts – non-official copies are sufficient for your application. At least one of your transcripts needs to indicate that you have been awarded a bachelor’s degree. If you are hired, please request that official transcripts of your college/university studies be sent to the Diocese of Gallup, Office of Catholic Schools. LETTERS OF REFERENCE FROM THE FOLLOWING THREE PERSONS (Required) ................ Item G., Page 4 m I have attached a letter from my current or last employer (if applicable, your last principal). m I have attached a letter from a professional colleague. m I have attached a letter from my pastor or minister attesting to my commitment to my faith. If you are not an active member of a parish or church and are unable to obtain a letter from your pastor or minister, include an explanation of your situation. STATEMENT OF INTENT (Required) .............................................................................................. Item H., Page 4 m I have attached my Statement of Intent: an essay response to the following question: “Why do you want to teach in a Catholic school?” RESUME (Optional) .......................................................................................................................... Item H., Page 4 m I have attached my resume. m I have not attached my resume. Thank you for applying for a teaching position in the Catholic schools of the Diocese of Gallup. We are always looking for teachers eager to touch the hearts and minds of our students. FOR OFFICE USE ONLY Date Application Received Date Application is Complete Application Transmitted to Schools School Date School Date