Faculty Employment Application

Position Date Submitted How or by whom were Date Available for Annual Salary Desired Click here to enter Click here to enter you referred to LCCS? Employment Click here to enter text. text. Click here to enter Click here to enter text. text. text.

The Immigration Reform and Control Act of 1986 prohibits the employment of unauthorized aliens, and requires employers to verify the employment eligibility of all new employees. An offer of employment made by Lake Country Christian School will be conditioned upon your providing the documentation required by law as evidence of your personal identity and your authorization to work in the United States. Any offer of employment is also conditional upon the successful completion of a background investigation.

Are you a U.S. citizen or national, permanent resident, temporary resident, legalization applicant, or refugee?

Yes__Click here to enter text._____ No___Click here to enter text._____

Temporary residence does not include those with non-immigrant work authorization (F, J, or L visas). A legalization applicant is one who is eligible and who has made a naturalization application within the regulatory time requirements of the INS. Exceptions to these requirements will be determined based on shortage of qualified candidates with a particular skill.

Personal Information Name (Last, First, M) Social Security No. Click here to enter text. Click here to enter text. Marital Status Previous/Different last name(s) used in past 7 years (please indicate Click here to enter text. N/A if you have no other names) Click here to enter text. Present Address City State Zip Click here to enter text. Click here to enter text. Click here to enter Click here to text. enter text. How long have you lived at this address? Contact Phone Drivers License State Issued: Click here to enter text. Click here to enter text. No.Click here to Click here to enter text. enter text. Email address: Click here to enter text. Are you Currently Employed? If so, may we inquire of your present employer? Click here to enter text. Click here to enter text. Have you ever applied to LCCS before? If so, when? Are you a former employee? Click here to enter text. Click here to enter text. Click here to enter text.

Certification

Do you hold a valid state teaching certificate? Click here to enter text.Yes (Please attach a copy) Click here to enter text.No

State: ___Click here to enter text.____ Type:____Click here to enter text._____Issue Date:______Click here to enter text.______

Do you hold a valid ACSI teaching certificate?

__Click here to enter text.__No _Click here to enter text.____Yes (Please attach a copy) Type:______Click here to enter text.______Issue Date:___Click here to enter text.______

Faculty Employment Application Page 2 Revised 12/2/2014 Education Name and Location of College or University Month & Year Type of Year of Degree Click here to enter text. AttendedClick here Degree Click here to (B.A., M.A.) to enter text. Click here to enter text. Name City State From To enter text. 1)Click here to enter Click here to Click here to Click here Click here Click here to Click here to enter text. to enter to enter enter text. text. enter text. text. text. enter text.

2)Click here to enter Click here to Click here to Click here Click here Click here to Click here to enter text. to enter to enter enter text. text. enter text. text. text. enter text.

3)Click here to enter Click here to Click here to Click here Click here Click here to Click here to enter text. to enter to enter enter text. text. enter text. text. text. enter text.

Chief Undergraduate Subjects Number of Credit Chief Graduate Subjects Number of Credit (Show major on first line) Hours Completed (Show major on first line) Hours Completed 1)Click here to enter text. Click here to Click here to enter text. Click here to enter text. enter text.

2)Click here to enter text. Click here to Click here to enter text. Click here to enter text. enter text.

Please attach a copy of your education transcripts. (Does not have to be a certified copy.)

Placement Information Please indicate what grades or subjects for which you are certified: Click here to enter text. Which grades or subjects do you prefer? Click here to enter text. What activities or organizations might you want to sponsor? Click here to enter text. Special Skills, Accomplishments, and Awards Give the title and year of any honors, awards, or fellowships you have received. List your special qualifications, skills or accomplishments that may apply to this position. Some examples are: skills with computers or other machines; coaching skills; public speaking and writing experience, articles published, membership in professional societies; etc. Description of Skill, Honor, Award, Etc. Years of Experience Date of Honor, Award, etc. with Skill Click here to enter text. Click here to Click here to enter text. enter text.

Click here to enter text. Click here to Click here to enter text. enter text.

Faculty Employment Application Page 3 Revised 12/2/2014 Employment History ATTACH RESUME HIGHLIGHTING RELEVANT WORK EXPERIENCE. Account for all time for the past ten years. Give all employment experience, starting with your present or most recent employer and working back ten years. Include full and part-time work, self-employment, military service, unemployment, and full-time education. Use additional sheet if necessary. These employers may be contacted for references.

From To MM/YYYY MM/YYYY Click Click Click Click Employer Name City/State Position Held here here here here to Click here to enter text. Click here to enter text. Click here to enter text. to to to enter enter ente enter text. Contact Name Contact Phone Reason for Leaving text. r text. Click here to enter text. Click here to enter text. Click here to enter text. text. Click Click Click Click Employer Name City/State Position Held Click here here here here here to Click here to enter text. Click here to enter text. to enter text. to to to enter enter ente enter text. Contact Name Contact Phone Reason for Leaving text. r text. Click here to enter text. text. Click here to enter text. Click here to enter text. Click Click Click Click Employer Name City/State Position Held here here here here to Click here to enter text. Click here to enter text. Click here to enter text. to to to enter enter ente enter text. text. r text. Contact Name Contact Phone Reason for Leaving text. Click here to enter text. Click here to enter text. Click here to enter text.

Click Click Click Click Employer Name City/State Position Held here here here here to Click here to enter text. Click here to enter text. Click here to enter text. to to to enter enter ente enter text. Contact Name Contact Phone Reason for Leaving text. r text. Click here to enter text. Click here to enter text. Click here to enter text. text.

Last Annual Salary Click here to enter text. Total number of years of full-time teaching experienceClick here to enter text.

References List five (5) people other than your church pastor or family members who know your qualifications and fitness for the position for which you are applying. Please contact these references and inform them an authorized LCCS staff member will be contacting them. Full Name of Reference Telephone Present Business or Home Address State Zip Code Numbers Click Click here to 1)Click here to enter text. Click here to Click here to enter text. here to enter enter text. enter text. text. Click Click here to 2) Click here to enter text. Click here to Click here to enter text. here to enter enter text. enter text. text.

Click Click here to 3) Click here to enter text. Click here to Click here to enter text. here to enter enter text. enter text. text.

Click Click here to 4) Click here to enter text. Click here to Click here to enter text. here to enter enter text. enter text. text.

Click Click here to 5) Click here to enter text. Click here to Click here to enter text. here to enter enter text. enter text. text.

Faculty Employment Application Page 4 Revised 12/2/2014 Religious and Educational Philosophy Briefly answer the following questions: 1. Why are you seeking a position in Christian education? Click here to enter text.

2. What do you believe to be the purpose of Christian education? Click here to enter text.

3. What do you consider to be the proper standard for classroom discipline? How would you implement and maintain this standard? Click here to enter text.

4. What areas do you feel are your strengths related to teaching? Your weaknesses? Click here to enter text.

5. How do/would you integrate your faith and Christian worldview into your teaching and subject matter? Click here to enter text.

Faculty Employment Application Page 5 Revised 12/2/2014 Christian Background

Have you made a profession of faith in Jesus according to Romans 10:9-10? Click here to enter text.Yes Click here to enter text.Date Click here to enter text.No Please relate this experience and describe your relationship to the Lord Jesus since that time. Click here to enter text.

Have you been water baptized? Click here to enter text. If so, when? Click here to enter text.

Our teachers are expected to be active and regular members. Would you have a problem with this requirement? Click here to enter text.

Do you attend church regularly? Click here to enter text.Yes Click here to enter text.No

If yes, Name of local church you attend Denomination or Affiliation Click here to enter text. Click here to enter text. Church Address Length of Time Attended Are you a member? Click here to enter text. Click here to enter text. Click here to enter text. Church activities you are involved in: Click here to enter text.

Other Christian Service: Click here to enter text.

Describe how you maintain your personal relationship with Christ: Click here to enter text.

Pastoral Recommendation Form At the end of this application is a Pastoral Recommendation Form that must be filled out and completed by a pastor from your home church. It can be mailed, emailed, or brought in to Mark Earwood, [email protected].

Statement of Faith and Honor Code Agreement and Signatures On the following pages are the Statement of Faith and Honor Code agreement for Lake Country Christian School. Applicants should read these carefully and sign if they agree.

Faculty Employment Application Page 6 Revised 12/2/2014 STATEMENT OF FAITH

We believe the Bible is the inspired, only infallible and authoritative written Word of God.

We believe there is one God manifested in three persons: the Father, the Son and Holy Spirit.

We believe in the reality of Satan and that his present control over unregenerate man does exist.

We believe in the deity of our Lord Jesus Christ, His virgin birth, His sinless life, His miracles, His vicarious and atoning death on the cross, His bodily resurrection and ascension to the right hand of the Father, and His personal return in power and glory.

We believe in the resurrection of believers into everlasting life and unbelievers into the everlasting punishment of hell.

We believe in the present supernatural ministry of the Holy Spirit by whose indwelling enables the Christian to live a Godly life.

We believe that the ministry of the Holy Spirit enables the Christian to live a godly life and the ministry, the infilling, and the manifestations of the Holy Spirit are available to every believer. The school is open to the fullness of God’s power in its programs and policies.

The school believes in the spiritual unity of the Body of Believers in our Lord Jesus Christ, no matter to which Bible-believing denomination or church they belong, ever seeking to become "more and more in every way like Christ, who is the head of His Body, the Church" (Ephesians 4:16).

Priority will be given to drawing all students to a personal salvation experience with Jesus Christ and to training them to live a selfless life that is pleasing to God, as revealed in His Word. (John 12:32; Matthew 5:16)

As a teacher/staff member, I have read the above and agree to be guided by these statements while employed at Lake Country Christian School.

Click here to enter text. Teacher/Staff Signature Click here to enter text. Date

Faculty Employment Application Page 7 Revised 12/2/2014 LCCS HONOR CODE

The purpose of the honor code is to provide a Biblical framework for personal conduct. In order to realize fully the unique plan that God has for me, I will seek to honor Him by making appropriate choices.

Twenty-four hours a day, twelve months a year, as long as I am a student at Lake Country Christian School I will commit to the following goals:

1. I will respect and honor administrators, teachers, faculty staff, parents, and adults in general. Respect by definition is courteous expression by word or deed of esteem or regard for the feelings and rights of others.

2. I will show respect, care, and concern for other students. Respect by definition is courteous expression by word or deed of esteem or regard for the feelings and rights of others. I will refrain from physical or verbal harassment of any kind (e.g. “initiation” of other students), putting down fellow students, sexual innuendo (sexual harassment), or gossip. Such behaviors are cruel, hurtful, and indicate a lack of character. I acknowledge that, though my intent may not be to cause harm with my words or actions, the perception of the recipient defines harassment.

3. I will maintain a lifestyle of sexual purity. In order to remain sexually pure, I will refrain from participation in sex acts or looking at, listening to, or sharing sexually explicit material. I understand that sexual intimacy is biblically set aside for marriage. Marriage is biblically defined as a covenant relationship between a man and a woman.

4. I will refrain from profanity, vulgar behavior, sexual perverse conversation or behaviors. I will refrain from any communication or actions which represent behaviors condemned by the Word of God.

5. I will not use illegal drugs. I will not abuse prescription drugs. I will not use any mood altering substances, legal or illegal. I will not use alcohol or tobacco. I will not be associated with the illegal use of alcohol and tobacco.

6. I will refrain from lying, cheating, or stealing. In addition to the commonly understood meanings of these words, I understand that stealing the ideas of others is plagiarism and using the work of others is cheating. I will refrain from any appearance of stealing, cheating, or lying.

7. I will hold my fellow students accountable for the principles held in this Honor Code. I will insist others do what is honoring to God. At the same time, I will not judge my fellow students or consider myself better than others.

The honor code is signed by all students entering grades 5-12.

As a teacher/staff member at LCCS, I understand that I am to model behaviors that support the Honor Code. Like my students I acknowledge that it is through the abiding presence of the Holy Spirit in my life that I am free to make right choices.

Click here to enter text. Click here to enter text. Signature Date

Faculty Employment Application Page 8 Revised 12/2/2014 Personal History Give all addresses for the past five (5) years, starting with your current address. Also provide city and state prior to the past five years during adult life. Street City State Zip Code From To Mo. Yr. Mo. Yr. Click here to Click here to enter Click Click Click here to enter text. Click here to enter text. enter text. text. here to here to enter enter text. text. Present

Click here to Click here to enter Click Click Click Click Click here to enter text. Click here to enter text. enter text. text. here to here to here to here to enter enter enter enter text. text. text. text.

Church History List churches you have attended regularly during the past ten (10) years. Church name Street Address City State Click here to enter text. Click here to Click here to enter text. Click here to enter text. enter text.

Click here to enter text. Click here to Click here to enter text. Click here to enter text. enter text.

Faculty Employment Application Page 9 Revised 12/2/2014 BACKGROUND INVESTIGATION CONSENT

I, Click here to enter text., hereby authorize Lake Country Christian School and/or its agents to make an independent investigation which may include information regarding background, references, criminal or police records, and Department of Motor Vehicle records, as part of the employment and/or volunteer process. At any time during the tenure of my employment or volunteer service, this report may be compiled by any source required to verify information that I have voluntarily supplies. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such an investigation includes information bearing on my character, general reputation, personal characteristics or mode of living.

I release Lake Country Christian School and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above references or sources used.

The following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge:

Full Name (First, Middle, Last) Click here to enter text.

Maiden or Other Names Click here to enter text.

Street Address Click here to enter text.

City, State, Zip Click here to enter text.

Phone Number Click here to enter text.

Driver License #: Click here to enter text. Issuing State of License: Click here to enter text. Copy of Driver’s License needed.

Click here to enter text. Click here to enter text. *Social Security Number *Date of Birth

Click here to enter text. Click here to enter text. Applicant Signature Date

Click here to enter text. Click here to enter text. Parent or Legal Guardian (if under age 18) Date

*NOTE: The above information is required for identification purposes only, and is in no manner used as qualification for employment. LAKE COUNTRY CHRISTIAN SCHOOL is an Equal Opportunity Employer and does not discriminate on the basis of Sex, Race, Age (40 and over), Handicap or National Origin.

Faculty Employment Application Page 10 Revised 12/2/2014 Legal History For any “yes” answers to the following questions, please attach a detailed explanation in writing. Yes No Click here Click here Have you ever plead guilty, or no contest to, or been convicted of any misdemeanor or felony? If Yes, please to enter to enter text. text. give the date(s) and details. Click here Click here Have you been arrested for any matters for which you are out on bail on your own recognizance pending to enter to enter text. text. trial? If Yes, please give the date(s) and details. Click here Click here Have you ever been charged with a sexual offense, offense relating to children, or crime of violence? to enter to enter text. text. Click here Click here Do you have any disciplinary action or investigation pending by an employer, other organization, to enter to enter text. text. professional association, or licensing body, for violence, sexual misconduct, or misconduct involving children? Click here Click here Has your teaching license or certificate ever been revoked? to enter to enter text. text. Click here Click here Have you ever received a formal or informal reprimand or any sanction of any kind against your teaching to enter to enter text. text. certificate? Click here Click here Have you been discharged or permitted to resign because you were convicted of fraud, wrongful taking of to enter to enter text. text. property, violating federal, state, or local laws, statutes, regulations, rules, or established standards of conduct? NOTE: Answering “YES” to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include traffic citations and arrests or convictions which have been sealed or expunged in answering these questions).

Signature, Certification, and Release of Information You must sign this application to be considered.

Read the following carefully before you sign.  I understand that a false statement on any part of this application may be grounds for not hiring me or for terminating my employment after I begin work. I will provide additional information, if requested, or provide verification of any information that I have given on this application.  I acknowledge that I have received and carefully read the LCCS Statement of Faith and Honor Code Statement. I support these statements and, if offered a position with LCCS, will adhere to their guidelines.  I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by LCCS that such employment may be terminated by either the school or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of LCCS or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of the school except the Head Administrator or his/her delegate has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the Head Administrator or his/her delegate.  I consent to the release of information about my qualifications, ability, and fitness for employment by former or current employers, schools, law enforcement agencies, and other individuals and organizations, to investigators, personnel staffing specialists, and other authorized employees of LCCS.  I understand that if offered a position with LCCS, I may be required to submit to a pre-employment medical examination, drug screening, and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.  I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete, and made in good faith. Signature (Sign application in ink) Click here to enter text. Date Click here to enter text.

Faculty Employment Application Page 11 Revised 12/2/2014 Authorization to Release Information

(Please read the following statements and sign below.)

I, Click here to enter text., hereby authorize any investigator or duly accredited representative of Lake Country Christian School (LCCS) bearing this release to obtain any information from schools, residential management agents, employers, criminal justice agencies, or individuals, relating to my activities. This information may include, but is not limited to, academic, residential, achievement, performance, attendance, personal history, disciplinary, arrest, and conviction records. I hereby direct you to release such information upon request of the bearer. I understand that the information released is for official use by LCCS and may be disclosed to such third parties as necessary in the fulfillment of official responsibilities.

I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or nature, which may at any time result to me on account of compliance, or any attempts to comply, with this authorization.

Click here to enter text. Applicant’s Name (Print)

Click here to enter text. Applicant’s Signature

Click here to enter text. Date

Faculty Employment Application Page 12 Revised 12/2/2014 Pastoral Recommendation Part I: (To be filled out by applicant)

Name: Click here to enter text.

Address: Click here to enter text.

Position Sought: Click here to enter text.

Part II: (To be filled out by the Pastor) Your recommendation is important to us as we consider the applicant(s) for employment at Lake Country Christian School. The mission of Lake Country Christian School is to educate, equip, and encourage Christian leaders to fulfill their God-given purpose in a changing culture. Please email the completed form to [email protected].

Is the applicant in active fellowship with your church? Yes Click here No Click here to enter text. to enter text. What is your understanding of their relationship to God? Click here to enter text.

In what areas of service and/or activities of the church is the applicant involved? Click here to enter text.

Do you know of any reason this applicant should not be considered for a position in the ministry of Lake Country Christian School? Click here to enter text.

Do you recommend this individual for employment to Lake Country Christian School? Yes Click No Click here to here to enter text. enter text.

Pastor’s Name: Click here to enter text. Pastor’s Signature: Click here to enter text. Church Name: Click here to enter text. Church Address: Click here to enter text. Church Phone: Click here to enter text. Date: Click here to enter text.

On behalf of Lake Country Christian School, thank you for taking time to fill out this form.

Faculty Employment Application Page 13 Revised 12/2/2014 Professional Reference Form

Our school has received an application for a teaching position from ______And would appreciate your opinion on the applicant’s character, personality, and ability to fill this position. On file is a signed authorization form whereby the applicant releases you from liability if you provide this reference. The applicant has also agreed that we have the right to keep your reference confidential. On behalf of Lake Country Christian School, thank you for taking time to fill out this form. Please return the completed form to [email protected]. Date: Reference’s Name: Click here to enter text. Click here to enter text. Name of Organization: Address: Click here to enter text. Click here to enter text. Daytime Phone: Evening Phone: Click here to enter text. Click here to enter text. Position held by applicant: Dates of Service: Click here to enter text. Click here to enter text. Type of Position: Full-Time or Part-Time? Reason for leaving: Click here to enter text. Click here to enter text. Would you have any reservations about rehiring this applicant? Click here to enter text. List the applicant’s main character and personality strengths: Click here to enter text.

Is there evidence that the applicant exemplifies Christian character so that they would be an exemplary role model for students? Click here to enter text.

Please comment about any matter pertaining to the applicant that might be pertinent to their consideration for employment at Lake Country Christian School: Click here to enter text.

Teacher Performance Please enter the number that most closely applies: 1 – Outstanding 2 – Above Average 3 – Satisfactory 4 – Improvement Needed 5 – No Opportunity to Observe Provides for biblical integration in subject areas Click here to enter text. Is consistently thorough in lesson planning and in securing necessary materials Click here to enter text. Uses a variety of teaching techniques and resources Click here to enter text. Demonstrates a knowledge of subject matter Click here to enter text. Understands and relates effectively to student needs Click here to enter text. Exhibits ability to arouse interest and to stimulate intellectual growth Click here to enter text. Is fair, firm and consistent when disciplining students Click here to enter text. Maintains effective classroom control Click here to enter text. Develops appropriate relationships with students Click here to enter text. Maintains voice control in the classroom Click here to enter text. Provides a well-organized, attractive classroom Click here to enter text.

Professionalism Follows ethical and professional practices Click here to enter text. Develops appropriate relationships with administration, staff, and parents Click here to enter text. Is assertive and authoritative as a staff member at appropriate times Click here to enter text. Accepts and acts upon supervisory guidance Click here to enter text.

Faculty Employment Application Page 14 Revised 12/2/2014