<p> CHRISTIAN BROTHERS HIGH SCHOOL 5900 Walnut Grove Road Memphis, Tennessee 38120-2174 901-682-7801</p><p>INSTRUCTIONS 1. File an official college transcript 2. Complete al items that are applicable on this form in your own handwriting in ink 3 Return the complete form to: Principal Christian Brothers High School 5900 Walnut Grove Rd. Memphis TN 38120-2174 Date of Application______</p><p>Date of Availability______PERSONAL DATA:</p><p>Name______Title Last First Middle or Maiden</p><p>Present Address______No. Street City State/Zip</p><p>Permanent Address______No. Street City State/Zip</p><p>Present Telephone No.______Summer/Business/ Permanent No.______</p><p>Your religions preference______Social Security No______</p><p>Date of Birth______Age______Place of Birth ______City State Email address: ______</p><p>POSITION FOR WHICH APPLICATION IS MADE:</p><p>Grade Level(s): 1st Choice______2nd______3rd______</p><p>Subject(s) (Grades 9-12)______</p><p>PREPARATION TO TEACH:</p><p>Degree(s) Bachelor □ Master □ Doctorate □ Other □</p><p>Overall college grade-point average______Out of a possible______</p><p>Type(s) of Tennessee Teachers’ Certificate(s)______Held or Expected______</p><p>Permanent □ Professional □ Temporary □ Other □ For grades □ □ □ 1-9 7-12 1-12 Number of Tennessee Certificate______List subjects in which you have 12 or more semester hours______</p><p>If your certificate is for 7-12 or 1-12, please list the subjects in which you are endorsed: ______</p><p>Total number of Education hours (including Psychology)______Qtr. □ Sem. □</p><p>EDUCATIONAL PREPARATION High School Name______Dates Attended______Location______Year of Graduation______</p><p>College or University Name______Location______Dates Attended______Year of Graduation______Degree Received______</p><p>Name______Location______Dates Attended______Year of Graduation______Degree Received______</p><p>Name______Location______Dates Attended______Year of Graduation______Degree Received______</p><p>Special Courses or Training Name______Location______Dates Attended______Nature of the training______</p><p>Name______Location______Dates Attended______Nature of the training______</p><p>Name______Location______Dates Attended______Nature of the training______</p><p>Indicate the areas in which you have training, experience, and/or interests and would be willing to serve as a sponsor. Yearbook______Sports______Student Government______Newspaper______Academic Club______Camera______Drama______Debate______Other______</p><p>ADDITIONAL DATA</p><p>Name of Spouse (if applicable)______Where Souse Employed______No. of Children______Ages______General Health the last two years______Physical impairments (sight, hearing, other)______Have you ever been arrested for an offense other than a minor traffic violation? If yes, explain on an attached sheet.</p><p>Why do you desire to leave your present position; or, why did you leave your previous position? ______</p><p>Why do you wish a position at Christian Brothers High School?______</p><p>TEACHING EXPERIENCE __ to ___ __ to ___ __ to ___ Position Name of school City and state Grades taught Subjects taught (attach another sheet if necessary)</p><p>OTHER WORK EXPERIENCE __ to ___ __ to ___ __ to ___ Position Employer City and State No. of Years</p><p>REFERENCES Name______Position______Address______Telephone______Street City State/Zip</p><p>Name______Position______Address______Telephone______Street City State/Zip</p><p>Name______Position______Address______Telephone______Street City State/Zip</p><p>Note: Mark “Hold” in front of any references whom you do not wish us to contact at the present time.</p><p>Signed ______TEACHER APPLICATION SUPPLEMENT (No. 1)</p><p>DIRECTIONS: Please answer each of the questions given below as best you can. The space provided should be adequate, but if more space is needed, please attach additional pages.</p><p>1. What do you want o accomplish as a teacher” ______</p><p>2. How will (do) you go about finding out about students’ attitudes and feelings concerning your class? ______</p><p>3. An experienced teacher offers you the following advice: “When you are teaching always command the respect of your students immediately and all will go well.” How do you feel about this? ______</p><p>4. How would you go about deciding what it is that should be taught in your class? ______</p><p>5. If a parent came to you and complained that what you were teaching a student was irrelevant to the student’s needs, how would you respond? ______</p><p>6. What will (does) provide you the greatest pleasure in teaching? ______7. What do you enjoy during your free time? ______</p><p>8. How would (do) you go about finding what students are good at? ______9. Would you rather try a lot of way-out teaching strategies or would you rather try to perfect the approach which works bet for you? Explain your position. ______</p><p>10. Do you like to teach with an overall plan in mind for the year, or would you rather just teach some interesting things and let the process determine the results”. Explain your position. ______</p><p>11. A student is doing poorly in your class. You talk to him and he tells you that he considers you to be the poorest teacher he has ever met. What would you do? ______</p><p>12. If there were absolutely no restrictions placed upon you, what would you most want to do in life? ______</p><p>13. Why do you want to teach in a Catholic school? ______</p><p>14. What do you feel you can contribute to the religious objectives of Christian Brothers High School? ______</p><p>15. What religious experiences do you feel are most important for adolescents? ______CHRISTIAN BROTHERS HIGH SCHOOL EMPLOYMENT APPLICATION SPECIAL QUESTIONS (Supplement 2)</p><p>1. Do you use illegal drugs and/or medication prescribed for someone other than yourself? YES____ NO___</p><p>2. Have you ever been convicted of a felony or misdemeanor (other than a minor traffic violation) in the last seven years? YES____ NO____ If yes, explain: ______</p><p>3 Have you ever been convicted of child abuse or neglect? YES____ NO____ If yes, explain: ______</p><p>4. Has your employment ever been terminated for reasons relating to a conviction of physical or sexual harassment: YES____ NO_____ If yes, explain: ______</p><p>5. Drivers’ License Number: ______Address listed on this license (Address, City, State, Zip Code): ______Expiration Date: ______</p><p>Has your drivers’ license ever been suspended or revoked? YES____ NO____ If yes, explain: ______</p><p>6. Current Address: (Address, City, State, Zip Code): ______</p><p>7. Current Phone Number, include area code:______</p><p>8. Date of Birth: ______Social Security Number:______Mo. Day Yr.</p><p>AUTHORIZATION: I understand that a criminal background check will be conducted (and if necessary a credit check). I also understand that I may not be considered for employment if I have been convicted of any of the following: Drug offenses including possession, distribution and use of a controlled substance or drug paraphernalia, sexual offenses, larceny, violent acts, sexual assault, contributing to the delinquency of a minor and driving under the influence of alcohol or drugs (DUI) within the last five years. I authorize Christian Brothers High School to conduct the aforementioned checks of my background and driving record.</p><p>Please PRINT your name:______</p><p>Signature:______Date:______</p>