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Do you hold a current credential?
If you do hold a teaching credential, please select the state that issued your credential
Please select California
Another US state
Please attach your valid teaching or sub credential
Name of College/University/School & Degree(s) Received
Name of Credential Program/Institution
Name of Graduate School(s) & Degree(s) Received
Please attached college/university/graduate school transcripts. If hired, unsealed transcripts will be required.
How many years of full-time, paid teaching experience do you have? (This does not include student teaching, paraprofessional, aide or assistant positions.)
Most Current Employer
Date Started and Date Ended (Current Employment)
Your Job Title (Current Employment)
Subjects/Grades Taught (Current Employment)
Name & Phone Number of Immediate Supervisor (Current Employment)
Reason for Leaving (Current Employment)
Are you currently under contract with any other district/county/school?
If so, with whom? And what is the expiration date?
Have you ever been dismissed or asked to resign from any position?
If you answered "Yes", please explain below.
Is there anything else that you would like us to know about you?
Please upload three letters of recommendation including one from an immediate supervisor. RECOMMENDATION ONE
Please upload three letters of recommendation including one from an immediate supervisor. RECOMMENDATION TWO
Please upload three letters of recommendation including one from an immediate supervisor. RECOMMENDATION THREE
List three references (including an immediate supervisor)
Please include their name, contact information, and role
Have you ever been convicted of a felony or misdemeanor, or do you currently have a felony or misdemeanor charge pending? Convictions include a plea of guilty, nolo contendere (no contest) and/or a finding of guilty by a judge or a jury, or a conviction that has been judicially dismissed or ordered sealed, including 'expungement' granted pursuant to Penal Code section 1203.4. (Note: Exclude convictions related to the use of marijuana that are over two years old).
If "Yes," list all convictions including, but not limited to convictions for "driving under the influence," and convictions for sex and/or drug offenses listed in California Education Code Sections 44010 and 44011, except for convictions related to marijuana if it is more than two years after the date of the conviction. Include any serious or violent felony conviction in any state or jurisdiction as enumerated in California Penal Code sections 667.6(c) and 1192.7(c). California Labor Code section 432.8 prohibition on asking about marijuana convictions does not apply to Health and Safety Code section 11359 (possession of marijuana for sale) and Health and Safety Code section 11378 (possession of a specific controlled substance). These convictions must be disclosed.
My submission of this on-line application authorizes the school to conduct a background investigation and authorizes release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal references, professional references, and other appropriate sources. I waive my right of access to any such information, and without limitation hereby release the school/County Office and reference source from any liability in connection with its release or use. I waive my right of access to any such information, and without limitation hereby release the school/County Office and reference source (except in relation to prior contractual agreements, public policy, legal/labor/education code, former employers and their agents or employees, as provided by law) from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: the local law enforcement agencies, information from the Central Criminal Records Exchange or either data on all criminal convictions or certification that no data on criminal convictions are maintained, information from the California or other State Department of Social Services Child Protective Services Unit and any locality to which they may refer for release of information to any findings of child abuse or neglect investigations involving me.
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U.S. Equal Opportunity Employment Information (Completion is voluntary)
Individuals seeking employment at Bullis Charter School are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
Completion of the form is entirely
voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
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A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Please select I am not a protected veteran
I identify as one or more of the classifications of a protected veteran
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OMB Control Number 1250-0005
Why are you being asked to complete this form?
We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.
Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at
www.dol.gov/ofccp. How do you know if you have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Autism Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS Blind or low vision Cancer Cardiovascular or heart disease Celiac disease Cerebral palsy Deaf or hard of hearing Depression or anxiety Diabetes Epilepsy Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome Intellectual disability Missing limbs or partially missing limbs Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS) Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression
Please select Yes, I have a disability, or have a history/record of having a disability
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1Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
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