Address (Street) *
Address (City) *
Address (State) *
Address (Zip Code) *
Do you currently have any relatives that are employed by or enrolled in Chester Community Charter School? *
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Yes
No
If yes, please list their names
Are you legally able to work in the U.S? *
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Yes
No
Years of related experience (Full-Time, Full-Year, Relevant Experience – substitute experience does not count) *
Highest Level of Education *
Please select High School (Not Completed)
GED
High School
Vocational School
CNA
Associate's
Bachelor's
Master's
Doctoral
District Policy: The School does not discriminate on the basis of race, color, national origin age, sex or disability, in admission or access
to, or treatment or employment in its programs and activities. Any person having inquiries concerning the School's compliance with the
regulations implementing Title VI of the Civil Rights Act of 1964 (Title VI), Section 504 of the Rehabilitation Act of 1973 (Section 504), or
Title II of the Americans with Disabilities Act of 1990 (ADA), may contact the Assistant Superintendent or Human Resources.
Application Confirmation Statement: I affirm that all information set forth in this application is accurate, truthful and complete. If I am
employed by the School, I will abide by all Board of Education and school policies, work on assigned committees, and continue my
professional growth to the best of my ability and within reasonable and personal standards. I grant permission for school officials to
obtain a personal record check from the federal, state, county, and/or local law enforcement agencies and Division of Family Services;
also a credit history check may be made. I release individuals listed as references and current or former employers from any liability for
information given in response to a request for an employment reference. I understand that I will be required to take a physical exam
prior to assuming any position for which I may be employed. In the event that I am employed by the School and in the further event that
I have provided false or misleading information in this application or in subsequent employment interviews, I understand that my
employment may be terminated at any time after the discovery of the false or misleading information. I understand that this application
will be considered active for one year from date of submission. Please agree to the terms above: *
Please select Affirm
Decline
Initials confirming you acknowledge our District Policy and Application Confirmation Statement *
Affirmation Date (Today's Date: mm/dd/yyyy) *
Do you have an active Pennsylvania teaching certification? *
What is your certification in? *
Are you comfortable submitting to an FBI and Pennsylvania State Criminal Record Check? *
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Yes
No
If certified, do you know your PPID number?
Voluntary Self-Identification
For government reporting purposes, we ask candidates to respond to the below self-identification survey.
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.
As set forth in Chester Community Charter School’s Equal Employment Opportunity policy,
we do not discriminate on the basis of any protected group status under any applicable law.
Gender
Please select Male
Female
Decline To Self Identify
Are you Hispanic/Latino?
Please select Yes
No
Decline To Self Identify
Please identify your race
Please select American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
White
Native Hawaiian or Other Pacific Islander
Two or More Races
Decline To Self Identify
Race & Ethnicity Definitions
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.
As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure
the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories
is as follows:
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.
Veteran Status
Please select I am not a protected veteran
I identify as one or more of the classifications of a protected veteran
I don't wish to answer
Voluntary Self-Identification of Disability
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Expires 04/30/2026
Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, 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?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes
Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury
Disability Status
Please select Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
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