Personal Information
Last Name / First Name / Middle Name / Maiden Name
Social Security Number / Email
Permanent Street City State Zip
Address
Previous Street City State Zip
Address
Home
Phone / Cell
Phone

Teacher Employment

Application

The Bridges Preparatory School (BPS) mission is to provide students equal access to a high quality K-12 whole child education that maximizes academic excellence and strength of character in a student-centered learning environment created by a faculty of lifelong learners.

Position Applying For
First Choice
Second Choice
Certification Information
Do you Presently hold a valid SC Credential? If yes, Credential Number ______
(Attach Copy) Type ______
Yes No No , but I have applied Expiration ______
Do you presently hold a valid credential from another state? Yes (Attach Copy) No
Have you taken the Praxis II? Yes No
Score ______
Are you currently certified by the National Board for Professional Teaching Standards? Yes No
If yes, what area? ______
Expiration date: ______
Education Information (Attach Transcripts)
Date / Name and Location of College or University
(graduate or undergraduate) / Degree(s)
Received / Major / Minor
From / To
Student Teaching (If completed within the last three (3) years)
Date / Grade/Subject / Supervising Teacher Info / School Information
From / To
Educator Experience (Teaching Experience Only)
Date / Grade/Subject / Position / School Details / Reason for Leaving
From / To
Employment Record (Other than teaching, including part time, for the past five (5) years)
Date / Employer / Job Description / Reason for Leaving
From / To
Personal and Professional Information
1. / Are you currently under contract? / If yes, expiration date:
Where? / When are you available?
Most recent contract held:
May we contact your current employer?
2. / Have you ever formally been evaluated under the SC ADEPT system? Rating:
3. / Have you ever failed to meet standard on any evaluation instrument? (TAP, another state’s evaluation, school level evaluation, etc.)
If yes, explain:
4. / Have you ever been involuntarily terminated, not had your contract renewed, or have you ever resigned from employment in lieu of being terminated?
If yes, explain:
5. / Have you ever had a teaching certificate revoked, suspended, or denied by any state; or is there any action pending against your certificate or application in any state? (Academic ineligibility is not considered grounds for denial of a certificate) If yes, then you must state where your certificate was revoked, suspended, denied or where action is pending against your certificate or application. If yes, please provide information for each charge below.
City/State / Date / Reason for Action / Disposition
6. / Have you ever been convicted, plead guilty, entered a plea of no contest, or paid a fine for any criminal offense, other than minor traffic violation such as speeding or driving too fast for conditions; or have you ever been arrested or ticketed for a criminal offense where the criminal charge is still pending? You must answer yes to this question for every conviction, plea or fine paid, no matter how long ago it occurred, unless the record of the criminal charge has been sealed or expunged by written court order. You also must answer yes to this question if you were ever arrested or ticketed and the charge was never formally dismissed, no matter how long ago the incident occurred. Failure to answer this question accurately and/or failure to provide all of the requested information could result in denial of certification.
City/State / Charge/Disposition / Date of Arrest
Military Service (If applicable)
Branch of Service: / From / To
Present Military Affiliation: None Reserve (Active) Reserve (Inactive)
Outside Activities/Hobbies
Professional Memberships, Certificates, or Licenses held:
Hobbies, Interest, Special Skills:
Languages (other than English):
Citizenship
Are you a United States Citizen? Yes No
If not, please explain current work status or visa: / Do you have an Alien Registration Number? Yes No
If yes, please include number:
Professional/Work References (List a total of three (3) references, two (2) past supervisors and one (1) other person, who is not related to you, who have knowledge of your qualifications for the position you are applying for.)
Name / Title / Address / Phone
Name / Title / Address / Phone
Name / Title / Address / Phone
I understand that Bridges Preparatory School will request a criminal history from the South Carolina Law Enforcement Division for past criminal convictions. Any offer of employment will be subject to receipt of a criminal history report reflecting no reasons for not extending such an offer.
My signature below certifies that any information provided on this application is true and I understand that any misrepresentation or omission of facts on my part will be justification of forfeiture for employment consideration or termination, if employed. I hereby authorize Bridges Preparatory School to request and receive confidential release of documentary materials relating to me by educational institutions I have attended; previous employers; and city, state and federal law enforcement agencies. I understand that employment may be contingent on verification of birth or an alien registration number and that employment depends on the will of BPS or me.
Signature ______Date ______
Bridges Preparatory School does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boys Scouts and other designated youth groups. For questions regarding the non-discrimination policies, please contact .

SC Public Charter School District

Permission for SLED Background Check and Child Abuse Prevention Assurance Form

Full Name (Print): ______

SSN: ______

Certificate #: ______

DOB: ______Gender: ______

Position (Teacher, volunteer, etc.): ______

I give my permission for ______and the SC Public Charter School District to conduct criminal background checks of local, state, and national law enforcement databases as a condition of my employment or volunteer position with ______.

In addition, I, ______, certify that I am not now nor have I been in the past the subject of an investigation pertaining to accusations or allegations or charges against me of child abuse, child neglect, or sexual abuse, harassment or exploitation of a child.

I have not been found guilty or convicted of any violation of law other than a traffic ticket.

Circle: Yes or No

If yes, provide explanation:

NOTICE: ______does not discriminate on the basis of race, gender, disability, age, religion, immigrant status, or national origin in its educational programs and employment practices.

All statements provided on this form, my application for employment, and references are true and accurate with full disclosure by me of all information pertinent to my employment or volunteer position in a K-12 educational setting.

Signature: ______Date: ______