Preferred first name
Preferred Pronoun(s)
How did you hear about this job? Please select: *
Please select DP Website
LinkedIn Search
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Professional Connection
Personal Connection
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DP Recruiter Message
DP Newsletter
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Other
If you indicated personal connection, professional connection, or other, please provide the name or source below.
Are you a current member or alumnus of any of the following programs?
Teach For America
TNTP
Urban Teachers
Blue Engine
MATCH Corps
City Year
How many years of full-time teaching experience do you have? *
Do you currently have your LMSW or LCSW? *
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Yes
No
If not, do you currently have your MSW? *
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Yes
No
What was your graduation date for your MSW? *
If you are currently enrolled in a post-secondary program, please share the degree you are working towards and your anticipated completion date.
Have you been enrolled in PERS (Public Employees Retirement System) before? *
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Yes
No
If yes, which plan?
Please select Shared (50/50)
ER (Employer Paid Plan)
Are you authorized to work in the United States? *
Please select Yes
No
If you answered "no" to the question above, please provide an explanation below:
Please note that these positions are available exclusively to permanent residents of the United States. Continued residency within the US is necessary for employment with us. Will you now or in the future require sponsorship for employment visa status (e.g., H-1B or J-1 visa status) or Green Card sponsorship in order to work for Democracy Prep Public Schools? *
Please select Yes
No
If you 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? *
Please select Yes
No
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. Notice to applicants: An applicant who willfully provides false information or fails to disclose the information required is subject to criminal prosecution, as well as a civil penalty of up to five hundred dollars and may face discipline up to and including termination or denial of employment. *
Please select Yes
No
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. *
Please select Yes
No
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. *
Please select Yes
No
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.) *
Please select Yes
No
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. *
Please select Yes
No
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. *
Please select Yes
No
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. *
Please select Yes
No
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. *
Please select Yes
No
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 Democracy Prep Public Schools’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
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Hispanic or Latino
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Two or More Races
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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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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
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