A. Desired Employment: Select up to 3 possible positions Preschool Principal / Teacher Kindergarten Principal / Teacher Elementary Principal / Teacher Junior High Principal / Teacher Senior High Principal / Teacher Administrative Staff Other Other Position Select Location East Campus West Campus Full Time Part Time Salary Expected Date you can start Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20262027 Referred by (if any) B. Personal Data: Full Name * Identity / Passport Number * Place of Birth * Date of Birth Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Present Address * Nationality * Phone / Fax Number * Mobile Phone Number * E-mail Address * Marital Status * Religion * Family: Name Family1Name Family2Name Family3Name Family4Name Family5Name Contact Number Family1ContactNumber Family2ContactNumber Family3ContactNumber Family4ContactNumber Family5ContactNumber Occupation Family1Occupation Family2Occupation Family3Occupation Family4Occupation Family5Occupation Relationship Family1Relationship Family2Relationship Family3Relationship Family4Relationship Family5Relationship Formal Education: Institution Name Education1Institution Education2Institution Education3Institution Year(s) Completed Education1Year Education2Year Education3Year Field of Study Education1Field Education2Field Education3Field Graduate / Degree GPA received Education1gpa Education2gpa Education3gpa Year degree received Education3YearDegree Education2YearDegree Education1YearDegree Workshops / Seminars Attended : Title of Seminar / Workshop Workshop1Title Workshop2Title Workshop3Title Institution / Organization Workshop3Institution Workshop2Institution Workshop1Institution City Workshop3City Workshop2City Workshop1City Year Workshop3Year Workshop2Year Workshop1Year Length of time Workshop3Length Workshop2Length Workshop1Length Organizational Membership(s): Name of Organization Organization1Name Organization2Name Organization3Name Position Held Organization1Position Organization2Position Organization3Position Years of Membership Organization3Years Organization2Years Organization1Years C. Employment History (List the last three employers, starting with the last one first) Former Employer 1 Employer Supervisor Employer Address Employer Phone Number / E-mail Address Dates Employed (Start - End) Starting & Final Salary Last Position Title Reason(s) for leaving Former Employer 2 Employer Supervisor Employer Address Employer Phone Number / E-mail Address Dates Employed (Start - End) Starting & Final Salary Last Position Title Reason(s) for leaving D. Job Data (Check all applicable areas in which you have had experience and / or training) Computer Skills Library Management Sunday School Teaching Writing & Editing Musical Instruments Counseling Accounting Electrical Engineering Building Maintenance Other Please Specifiy Musical Instrument Please Specifiy Other Experience E. Health How would you describe your general health ? Hearing Eyesight Physical disabilities, if any Date of last physical examination Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 F. General Information Have you ever applied for any position at Buah Hati / Cita Hati Christian School ? Yes No Do you have any friends / relatives working at Buah Hati / Cita Hati Christian School? (Please Specify) For local staff applicants only. Have you ever taken any work-related / psychological tests or any others ? Yes No If so, please specify type and purpose of test, along with when and where it was held: For local staff applicants only. What level would you like to teach ? What level have you taught ? What is your ultimate goal professionally ? How do you plan to reach that goal ? Please explain : Check all that applies : I own a house I own a vehicle I have a legal driver's license License Type & Number Do you possess the following habits listed? Check all that applies : Smoking Substance Abuse (i.e. Drugs & Alcohol) Gambling Have you ever been convicted of a crime / felony ? Yes No If so, please specify year and crime convicted : Are you willing to support us with regards of morality, dress code, and Christian beliefs ? Yes, I am willing No, I am not willing Are you willing to be placed in any position under Buah Hati / Cita Hati Christian School ? Yes, I am willing No, I am not willing Are you willing to work overtime if required ? Yes, I am willing No, I am not willing Are you willing to abide by the rules of Buah Hati / Cita Hati Christian School ? Yes, I am willing No, I am not willing G. Character Reference (Please list two references other than your relatives or previous employers) Reference 1 Name Address Phone Number Email Address Occupation Years Known Relationship Reference 2 Name Address Phone Number Email Address Occupation Years Known Relationship H. Additional Information (Please do not complete if not applicable) Name & Address of Church Denomination Name of Pastor Please list any religious or social activities Please describe your statement of faith Electronic Signature Agreement : I agree that typing in my full name below will act as my electronic signature to this document. By signing below, I certify that all the information submitted by me on this application is true and complete to the best of my knowledge. I understand that any willfull misstatement may lead to disqualification of my application or termination of my employment at Buah Hati / Cita Hati Christian School. Electronic Signature Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year202620272028
