Name:

School Applying For:

Present Address:
Street:
City:   State:AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming   Zip Code:

Alternate Address:
Street:
City:   State:AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming   Zip Code:

Home Phone: (123) 456-7890

Mobile Phone: (123) 456-7890

Email Address:

Are you a citizen of the United States? noyes
If not, have you received INS authorization to work in the United States? noyes
Please provide proper documentation.

Please list any license, certifications and specialized training:

Please list your qualifications:

What languages do you speak?
(indicate read/write/speak levels of low/med/high)

Education
(School or Institution, Address, Degree Received, Major, Minor, Date of Degree)

List your most recent employment
(Dates, Employer, Responsibilities)

List your computer skills
(list all programs you are proficient in)

Other Relevant Experience
(Name of Employer, City/State, Job Title, Dates Employed Mo/Yr to Mo/Yr)

Personal References (List Three)

In accordance with Utah State Law, applicant consents that SCHOOL may conduct a criminal background check, and I hereby waive my rights to written notice of such.

No applicant for employment shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any educational program or activity on the basis of sex, race, religion, age, national origin or disability. Accommodations will be made as necessary for applicants with disabilities. If accommodations are necessary, please contact Crista Sanchez at Academica West at (801) 444-9378.

In connection with my application for employment with SCHOOL, I hereby authorize the SCHOOL to investigate my past and present work, education, and law enforcement records to ascertain any and all information which may be pertinent to my qualifications. I do hereby release all persons, firms, agencies, companies, groups or installations from any damages of, or resulting from, providing such information. I further agree that a copy of this release shall function as an original.