Faculty Application Form printable pdf download

FACULTY APPLICATION

We are an equal opportunity employer, dedicated to non-discrimination in employment

on the basis of race, color, age, sex, national origin, disability or veteran status.

Position _______________________________________________________

Date ___________________________

Name __________________________________________________________________________________________

First

Middle

Last

Maiden

Address_________________________________________________________________________________________

Street

City

State

Zip

Telephone _____________________________________________

Email ________________________________

Cell

Home

Social Security Number ___________________________

If related to anyone who works with the Diocese, provide name, department, and location__________________

________________________________________________________________________________________________

Date available for employment ______________

Have you applied with diocese before? ___Yes ___ No

Are you currently employed? ___Yes ___No

May we inquire of your present employer? ___Yes ___No

Is there any reason why you might be unable to perform consistently and promptly any teaching, coaching, or

sponsoring duties? ___ Yes

___ No

If yes, please explain ________________________________________

_____________________________________________________________________________________________

Do you have any physical or mental condition which may limit your ability to perform work for which you have

applied?________________________________________________________________________________________

If hired, can you provide written evidence of a right to work in the U.S.? ______ Yes _______ No

Have you served in the U. S. military? ______ Yes

______ No

Dates of service _______________________

From

Type of discharge_________________________________

Reserve status _______________________

Have you ever been disciplined or fired? ____________________________________________________________

Have you ever been convicted of a crime, entered a plea of “no contest”, had prosecution deferred or

adjudication withheld for any crime, except a minor traffic violation?

_______ Yes _______No

If yes, please state the following: Number of convictions_______

Date of conviction(s)_________________

Nature of offense(s)________________________________

Your age at time of conviction(s)_________

“PREPARING YOUNG PEOPLE FOR COLLEGE AND FOR LIFE"

1055 Kingman Avenue

Jacksonville, FL 32207

Phone: 904/398-7545

Fax: 904/398-5728

Faculty Application Form

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