Preferred First Name
Are you a current member or alumnus of any of the following programs?
Teach For America
Have you completed a 4-year bachelor's degree from an accredited college or university?
What was your cumulative undergraduate GPA?
What was your cumulative graduate GPA?
Do you hold any professional teaching certifications?
If yes, please list certification area, grade level, state, and expiration date.
Are you authorized to work in the United States?
If you answered "No" to the question above, please provide an explanation below.
Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status) in order to work for Democracy Prep Public Schools?
If you've answered "Yes" to the question above, please provide an explanation below.
Consistent with applicable law, Democracy Prep employees are subject to criminal background checks. To the best of your knowledge, do you have a pending criminal charge or a criminal conviction in any jurisdiction?
If you answered "Yes" to the question above regarding criminal history, please provide each of the following: (1) a brief summary of the conduct that led to the criminal conviction(s) and/or pending criminal charge(s), (2) the current status of the criminal conviction(s) and/or pending criminal charge(s), and (3) any other relevant information, including an explanation of how Democracy Prep can feel confident that such conduct will not be repeated and will not affect your work with Democracy Prep. Please note that one or more pending criminal charges and/or criminal convictions will not necessarily bar you from working for Democracy Prep. However, we prefer to know about such issues in advance of your background check.
I certify that all the information I have provided in order to apply for and secure work with this employer is true, complete, and correct. I expressly authorize, without reservation, the employer its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and education institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. The information that I am providing here in the application and in the hiring process, including but not limited to information from the phone screen, demo lesson, and interview, will be used for research purposes to improve DPPS’s selection methods. I understand that all personally identifiable information will be kept confidential and will not be shared with non-research partners.
The remainder of the questions are pursuant to Chapter 391 of Nevada Revised Statutes, as amended by Assembly Bill 362 in the 2017 Legislative Session. Please list your current employer's name, address, telephone number and any additional contact information.
I am currently employed in a position that involves direct contact with children.
List all previous employment (employer's name, dates employed, address, phone number and any additional contact information) with any school or school district, or with any other entity or agency with which your employment involved direct contact with children.
Pursuant to Chapter 391 of Nevada Revised Statutes, as amended by Assembly Bill 362 during the 2017 Legislative Session, I understand that: “Sexual misconduct” means any act, including, without limitation, any verbal, nonverbal, written or electronic communication or physical activity, directed toward or with a child, regardless of the age of the child, that is designed to establish a romantic or sexual relationship with the child. • “Sexual offense” has the meaning ascribed to it in NRS 179D.097. • Nothing in Chapter 391 of NRS shall be construed to: 1. Prevent a board of trustees of a school district, governing body of a charter school, governing body of a university school for profoundly gifted pupils or independent contractor from: (a) Conducting further investigations of a prospective employee; or (b) Requiring an applicant to submit additional information or authorizations beyond what is required by sections 8, 9 and 10 of Assembly Bill 362 during the 2017 Legislative Session. 2. Prohibit a person or governmental entity from disclosing more information than is required by sections 8, 9 and 10 of Assembly Bill 362 during the 2017 Legislative Session. 3. Relieve a person of a duty to report prescribed by NRS 432B.220 or any other provision of state or federal law. • Any information collected pursuant to this form and Assembly Bill 362 during the 2017 Legislative Session is confidential and is not a public book or record within the meaning of NRS 239.010. By clicking yes, you are acknowledging that you have read and understood Chapter 391 of Nevada Revised Statutes, as amended by Assembly Bill 362 during the 2017 Legislative Session.
Have you ever been the subject of an investigation concerning an alleged sexual offense conducted by an employer, licensing agency, law enforcement agency, agency which provides child welfare services or child protective services, or a similar agency. (An applicant is not required to provide this information if, after investigating the alleged violation, the employer or agency determined that the allegations were false, unfounded, unsubstantiated or inconclusive.)
Have you ever been discharged, disciplined, or asked to resign from employment; had a contract not renewed; or resigned or otherwise separated from employment while an investigation concerning an alleged sexual offense was pending, or upon conclusion of such an investigation where you were found to have committed the sexual offense.
Have you ever had a license or certificate suspended or revoked, or been required to surrender a license or certificate, while an investigation concerning an alleged sexual offense was pending, or upon conclusion of such an investigation where you were found to have committed the sexual offense.
If you’ve answer "yes" to any of the immediate 3 questions above, please provide any relevant details below.
By typing your name, you hereby certify that you have answered all the above questions accurately to the best of your knowledge and ability.
Pursuant to Chapter 391 of Nevada Revised Statutes, as amended by Assembly Bill 362 in the 2017 Legislative Session, I understand that any applicant for employment who knowingly provides false information or willfully fails to disclose any information required above: (a) Is subject to discipline, including, without limitation, suspension or revocation of the person’s license pursuant to NRS 391.330 or 391.750, termination of employment and a civil penalty of not more than $10,000 per violation. (b) Is guilty of a misdemeanor.
I hereby authorize all employers and former employers listed on this form to release to Democracy Prep Public Schools, any and all information requested on this form or required by NRS Chapter 391 as amended by Assembly Bill 362 during the 2017 Legislative Session.
If you indicated Personal Connection, Professional Connection, or Other, please provide the name or source below.
How did you hear about this job?
Please select DP Website
College Career Center or Professor
DP Recruiter Message
Teach for America
U.S. Equal Opportunity Employment Information (Completion is voluntary)
Individuals seeking employment at Democracy Prep Public Schools 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.
Please select Male
Decline To Self Identify
Are you Hispanic/Latino?
Please select Yes
Decline To Self Identify
Please identify your race
Please select American Indian or Alaskan Native
Black or African American
Hispanic or Latino
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 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.
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
OMB Control Number 1250-0005
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities
1. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I 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:
Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation)
Please select Yes, I have a disability (or previously had a disability)
No, I don't have a disability
I don't wish to answer Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
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.
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.