Teacher Employment
Application
The Bridges Preparatory School (BPS) mission is to provide students equal access to a high quality K-12 whole child
education that maximizes academic excellence and strength of character in a student-centered learning
environment created by a faculty of lifelong learners.
Personal Information
Last Name
First Name
Middle Name
Social Security Number
Permanent
Address
Previous
Address
Maiden Name
Email
Street
Street
Home
Phone
City
State
City
State
Zip
Zip
Cell
Phone
Position Applying For
First Choice
Second Choice
Certification Information
Do you Presently hold a valid SC Credential?
(Attach Copy)
Yes
No
No , but I have applied
If yes, Credential Number ___________________________
Type ______________________________
Expiration __________________________
Do you presently hold a valid credential from another state?
Have you taken the Praxis II?
Yes
(Attach Copy)
No
Score ______
Are you currently certified by the National Board for Professional Teaching Standards?
If yes, what area? __________________
Expiration date: __________________
No
Yes
Yes
No
Education Information (Attach Transcripts)
Date
From
Name and Location of College or University
(graduate or undergraduate)
To
Degree(s)
Received
Major
Minor
Student Teaching (If completed within the last three (3) years)
Date
From
Grade/Subject
Supervising Teacher Info
School Information
School Details
Reason for Leaving
To
Educator Experience (Teaching Experience Only)
Date
From
Grade/Subject
Position
To
Employment Record (Other than teaching, including part time, for the past five (5) years)
Date
From
Employer
Job Description
Reason for Leaving
To
Personal and Professional Information
1.
Are you currently under contract?
Where?
Most recent contract held:
May we contact your current employer?
If yes, expiration date:
When are you available?
2.
Have you ever formally been evaluated under the SC ADEPT system?
3.
Have you ever failed to meet standard on any evaluation instrument? (TAP, another state’s evaluation, school level
evaluation, etc.)
Rating:
If yes, explain:
4.
Have you ever been involuntarily terminated, not had your contract renewed, or have you ever resigned from
employment in lieu of being terminated?
If yes, explain:
5.
Have you ever had a teaching certificate revoked, suspended, or denied by any state; or is there any action pending
against your certificate or application in any state? (Academic ineligibility is not considered grounds for denial of a
certificate) If yes, then you must state where your certificate was revoked, suspended, denied or where action is
pending against your certificate or application. If yes, please provide information for each charge below.
City/State
Date
Reason for Action
Disposition
6.
Have you ever been convicted, plead guilty, entered a plea of no contest, or paid a fine for any criminal offense,
other than minor traffic violation such as speeding or driving too fast for conditions; or have you ever been arrested
or ticketed for a criminal offense where the criminal charge is still pending? You must answer yes to this question
for every conviction, plea or fine paid, no matter how long ago it occurred, unless the record of the criminal charge
has been sealed or expunged by written court order. You also must answer yes to this question if you were ever
arrested or ticketed and the charge was never formally dismissed, no matter how long ago the incident occurred.
Failure to answer this question accurately and/or failure to provide all of the requested information could result in
denial of certification.
City/State
Charge/Disposition
Date of Arrest
Military Service (If applicable)
Branch of Service:
Present Military Affiliation:
None
Reserve (Active)
From
Reserve (Inactive)
To
Outside Activities/Hobbies
Professional Memberships, Certificates, or Licenses held:
Hobbies, Interest, Special Skills:
Languages (other than English):
Citizenship
Are you a United States Citizen? Yes
No
If not, please explain current work status or visa:
Do you have an Alien Registration Number? Yes
If yes, please include number:
No
Professional/Work References (List a total of three (3) references, two (2) past supervisors and one (1)
other person, who is not related to you, who have knowledge of your qualifications for the position you are applying for.)
Name
Title
Address
Phone
Name
Title
Address
Phone
Name
Title
Address
Phone
I understand that Bridges Preparatory School will request a criminal history from the South Carolina Law
Enforcement Division for past criminal convictions. Any offer of employment will be subject to receipt of a criminal
history report reflecting no reasons for not extending such an offer.
My signature below certifies that any information provided on this application is true and I understand that any
misrepresentation or omission of facts on my part will be justification of forfeiture for employment consideration or
termination, if employed. I hereby authorize Bridges Preparatory School to request and receive confidential release of
documentary materials relating to me by educational institutions I have attended; previous employers; and city, state and
federal law enforcement agencies. I understand that employment may be contingent on verification of birth or an alien
registration number and that employment depends on the will of BPS or me.
Signature _____________________________________________________________
Date _________________
Bridges Preparatory School does not discriminate on the basis of race, color, national origin, sex, disability, or age in
its programs and activities and provides equal access to the Boys Scouts and other designated youth groups. For
questions regarding the non-discrimination policies, please contact info@bridgespreparatoryschool.org.
SC Public Charter School District
Permission for SLED Background Check and Child Abuse Prevention Assurance Form
Full Name (Print): ______________________________________________
SSN: _________________________________________________________
Certificate #: __________________________________________________
DOB: _______________________Gender: __________________________
Position (Teacher, volunteer, etc.): ________________________________
I give my permission for _______________________________ and the SC Public Charter School District to conduct
criminal background checks of local, state, and national law enforcement databases as a condition of my employment or
volunteer position with ____________________________________.
In addition, I, ___________________________________, certify that I am not now nor have I been in the past the
subject of an investigation pertaining to accusations or allegations or charges against me of child abuse, child neglect, or
sexual abuse, harassment or exploitation of a child.
I have not been found guilty or convicted of any violation of law other than a traffic ticket.
Circle: Yes or No
If yes, provide explanation:
NOTICE: ___________________________ does not discriminate on the basis of race, gender, disability, age, religion,
immigrant status, or national origin in its educational programs and employment practices.
All statements provided on this form, my application for employment, and references are true and accurate with full
disclosure by me of all information pertinent to my employment or volunteer position in a K-12 educational setting.
Signature: ____________________________________________ Date: _________________________