<p> FAMILY CHRISTIAN ACADEMY 14718 Woodford, Houston TX 77015 (713) 455-4483 Fax (713) 455-2918</p><p>EMPLOYMENT APPLICATION</p><p>PERSONAL DATA</p><p>Name First Name Last Name Social Security Number 123-456-789</p><p>12345 Main Street Any City TX 77015 Address City State Zip</p><p>Phone ( 713 ) 455-4483 Age 99 Date of Birth 1/1/1990 </p><p>Marital Status Married</p><p>Spouse's Name Spouse's Name </p><p>Children/Ages Child's Name / Age , Child's Name / Age , Child's Name / Age , Child's Name / Age </p><p>Have you ever been convicted of child abuse or a crime involving a minor? Yes If yes, please explain. </p><p>Have you ever been convicted of a crime other than traffic violations? Yes If yes, please explain. </p><p>EDUCATION</p><p>High School Diploma? Yes</p><p>Institution Dates attended Major Minor # Credits Degree Earned</p><p>If degree is incomplete, number of total credits earned? </p><p>Do you hold a teaching certificate? Yes</p><p>What are your future educational goals, if any? </p><p>Would you be willing to finish your degree or take additional college courses? Yes</p><p>Describe any other courses or training completed that would relate to the position for which you are applying. </p><p>Page 1 of 5 Give any additional experience you have had in the education or care of children. </p><p>EMPLOYMENT</p><p>Current or last employer Position/Assignment</p><p>Address Annual Salary</p><p>Reason for leaving Dates Employed</p><p>Employer Position/Assignment</p><p>Address Annual Salary</p><p>Reason for leaving Dates Employed</p><p>Employer Position/Assignment</p><p>Address Annual Salary</p><p>Reason for leaving Dates Employed</p><p>Page 2 of 5 REFERENCES</p><p>Please list three (3) character references (not relatives or former employees).</p><p>( 713 ) 455-4483 Name Phone number</p><p>Address Relation</p><p>( 713 ) 455-4483 Name Phone number</p><p>Address Relation</p><p>( 713 ) 455-4483 Name Phone number</p><p>Address Relation</p><p>CHRISTIAN SCHOOL INFORMATION</p><p>Give summary of experience in Christian day schools </p><p>What courses have you had giving specific training for Christian day schools and where taken </p><p>Please comment on the Lord's leading in your life toward the Christian day school </p><p>On the back of this page, give what you believe to be the distinctive characteristic that makes a Christian school different from a public school.</p><p>Page 3 of 5 HEALTH</p><p>Do you have any allergies (please specify)? Yes </p><p>Are you currently under treatment (please specify)? Yes </p><p>Are you on regular medication (please specify)? Yes </p><p>Do you have any physical defects (please specify)? Yes </p><p>Do you use tobacco in any form (please specify)? Yes </p><p>How would you describe your general health? </p><p>SPIRITUAL</p><p>Church currently attending Denomination</p><p>( 713 ) 455-4483 Address Phone number</p><p>Pastor</p><p>How often do you attend services? </p><p>How long have you attended this church? </p><p>Have you accepted Jesus Christ as your personal Lord and Savior? Yes Date </p><p>Have you been water baptized by immersion? Yes Have you been baptized in the Holy Spirit with the evidence of speaking in other languages? Yes</p><p>Who has had the greatest spiritual influence on your life and how? (Use the back of this page to answer).</p><p>Where does the "Great Commission" fit in with the Christian school? </p><p>Describe any type of Christian service, other than Christian day school, in which you have been involved. </p><p>Do you drink alcoholic beverages? Yes</p><p>Page 4 of 5 PLACEMENT</p><p>Full-time employment Part-time employment</p><p>Which grades/subjects do you feel qualified to teach? </p><p>What other grades/subjects are you willing to teach? </p><p>What other school activities could you sponsor or assist? </p><p>Family Christian Academy selects qualified persons for employment without regard to race, sex, or national origin, but does, however, reserve the right to use established selection criteria in support of its goals and objectives. All information submitted will be held in confidence.</p><p>I have read the Statement of Faith of Family Christian Acadamy and am in agreement with its doctrine and principles. I hereby state that all information on this application and presented by me in the application process is true and correct. I understand that any attempt on my part to submit false or misleading information may preclude future employment with this school.</p><p>Signature of ApplicantBy fill this blank, you agree that it is electronically signed Date 6/27/2008</p><p>FOR OFFICE USE ONLY:</p><p>ITEM DATE ACCOMPLISHED Application Transcripts Letters of Recommendation Statement of Faith Certification Reference Check Interview Scheduled Letters of Employment/Non-Employment Contract Signed Payroll Information Spiritual Development Plan Professional Development Plan Physical Development Plan COMMENTS:</p><p>Page 5 of 5</p>