First Name:
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Last Name:
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Phone:
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Cell Phone
Does Community Education have permission to give your phone number to potential class participants in order to answer specific questions about your class? If so, which phone number?
Email:
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Address:
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Address:
City:
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State:
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Zip:
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Education completed, please select all that apply:
High School
University
Post University
Other
Education comments, if you desire:
Please list 3 references including name and phone number.
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Class Title
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Class Description (subject to editorial revision)
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Is this class for Youth or Adults?
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Minimum Age Requirement for Participants
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Day(s) of week class will meet
Monday
Tuesday
Wednesday
Thursday
Friday
Dates class will meet
Time class will meet
Preference for class location & type of room needed
Time you need access to classroom
List any equipment your class requires (Sink, Water, TV/VCR, Overhead Projector, Carpeted Floor, etc.)
What should students bring to class (if anything)?
Will you be providing any supplies to students? If so, please list:
Would you like to be reimbursed for these supplies, and at what amount per student?
Minimum number of students you desire in class
Maximum number of students you desire in class
Will Community Education be preparing handouts for your class?
Do you have previous experience teaching classes?
Do you have additional certifications, talents, or skills that are applicable to teaching this class?
Have you ever been discharged from past employment? Explain:
Provide a brief biographical sketch, which includes your education or experiences related to the proposed subject matter, prior teaching experiences and relevant awards, achievements or certifications, if any. (Example: Dave Free is certified by the Minnesota Department of Public Safety to offer Defensive Driving. He has been teaching these courses for 6 years).
I agree to the following Terms and Conditions of Employment at Bemidji Area Schools Community Education
I hereby authorize and request any and all of my former employers and other person, firm, or corporation to furnish any and all information concerning me and my personal background and I hereby release each such employer or other person, firm or corporation from any and all liability by reason of furnishing the requested information.
I understand that in connection with this application, a report may be requested whereby information is obtained through personal interviews with my neighbors, friends, or associates or with others with whom I am acquainted or who may have knowledge with respect to my character, general reputation, personal characteristics and mode of living, and hereby authorize the procurement of any such report.
I understand that if employed: 1)any misrepresentation or omission of facts requested in this application is cause for dismissal; and 2) my employment is for no definite period and I may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.
Once an offer of employment has been made: I agree to submit a physical examination at the employer’s expense by a doctor designated by the employer prior to final acceptance of employment, if requested, and at subsequent intervals as the employer may direct, it being understood that such medical examinations are to determine my physical fitness for continued employability in the event I am employed.
I agree, if employed, to devote my best efforts to the performance of my duties, to comply with all rules and regulations of the employer, and to obey all lawful directives of supervisors designated by the employer. I agree to give School District 31 at least fourteen days prior notice in the event of my resignation.
Alien Status: By law, no one can be employed without proof of citizenship or resident alien status. The final candidate for each position will be requested to complete an INS form. Appropriate identification will be required when completing payroll information.
Child Support: If employed by us, you will be required to inform us if you have court-ordered child support obligations that are required by law to be withheld from income and the terms of the court order, if any.
Background Check: If you are chosen as the final candidate for any position, you must provide us with a cashier’s check, money order or cash in the amount of $17.00. The cashier’s check or money order must be made payable to Bemidji Area Schools.