Employment Application Step 1 of 7 14% It is the policy of this organization to provide equal employment opportunities to all qualified persons without regard to race, color, sex, age, national origin, ancestry, disability, military status or any other protected classification in accordance with applicable federal, state and local laws. Position Applying For*Date of Application* Date Format: MM slash DD slash YYYY Personal InformationName* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* I am an U.S. Citizen or otherwise authorized to work in the United States on an unrestricted basis* Yes No If applicable, please list your visa type, visa# and expirationAvailability* Full Time Part-time/ Internship / Student Teaching What hours are you willing to work?*When would you be able to start?* Date Format: MM slash DD slash YYYY How did you learn about the position for which you are applying (please include name of job posting site if applicable)? Employment HistoryEmployer*City/State*Your Position*Duties*Dates of Employment*Supervisor* Name Title May we contact?* Yes No Reason For Leaving* Prior Employer EmployerCity/StateYour PositionDutiesDates of EmploymentSupervisor Name Title May we contact? Yes No Reason For Leaving Prior Employer EmployerCity/StateYour PositionDutiesDates of EmploymentSupervisor Name Title May we contact? Yes No Reason For Leaving Educational History & Skills Graduate/Technical/Vocational School InstitutionCity/StateDid you graduate? Yes No Dates AttenedDegreeMajorSpecial Honors or AwardsCollege or UniversityInstitutionCity/StateDid you graduate? Yes No Dates AttenedDegreeMajorSpecial Honors or AwardsHigh School/Other Classes/Training InstitutionCity/StateDates AttendedDescription of Classes/TrainingDegree or CertificationSkills & ActivitiesPlease list any other experience, job related skills, additional languages or other qualifications that should be considered in evaluating your qualification for employment Spiritual InformationHave you accepted Jesus Christ as your personal Lord and Savior?* Yes No If Yes, when?Do you believe the Bible to be the only inspired and infallible Word of God, our final authority in all matters of faith, truth and conduct?* Yes No If no, please explainHow often do you read your Bible?*How often do you pray?*Do you currently have a church home?* Yes No If yes, name the church & cityIf yes, how often do you attend?If yes, are you presently a member in good standing?What activities are/were you a part of at your local church?*Have you been attending church regularly (weekly) for the past 12 months?* Yes No If no, please explainHow important do you think it is to attend church regularly as it relates to your ability to do your job?* Essential Very Important Somewhat Important Not that important/unrelated to job Do you ever consume or use any alcoholic beverages?* Yes No If yes, how often?Do you ever consume or use any tabacco products?* Yes No If yes, how often?Doctrinal Positions Please explain briefly what you believe about the followingTithingThe Holy SpiritSpeaking or praying in tonguesHealingSpiritual Authority and Delegated AuthorityMy Christian TestimonyPlease give a brief description of how you came to receive your salvation through Jesus Christ STATEMENT OF FAITH – WE BELIEVE The Bible is the inspired and only infallible and authoritative Word of God. There is one true God, eternally existent in three persons: God the Father, God the Son, and God the Holy Spirit. In the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death, in His bodily resurrection, in His ascension to the right hand of the Father, in His personal, future return to the earth in power and glory. In the Blessed Hope, the rapture of the Church at Christ’s coming. In the fall and sinfulness of man and that the only means of being cleansed from sin is through repentance and faith in the precious blood of Christ. Regeneration by the Holy Spirit is absolutely essential to personal salvation. In Divine Healing of the human body provided through the redemptive work of Christ on the Cross. The Baptism of the Holy Spirit, according to Acts 2:4, 2:39, is given to believers who ask for it. The Church of Jesus Christ is the universal, spiritual body of believers from every tribe, tongue, kindred and race of peoples and is indwelt by God through the Holy Spirit and divinely empowered to fulfill the Church and her Great Commission on earth. In the sanctifying power of the Holy Spirit by whose indwelling the Christian is enabled to live a holy life. In the resurrection and final judgment of both the saved and the lost, the one to everlasting life and the other to everlasting damnation. In the new heavens and the new earth and the holy Jerusalem, the city of God, descending out of heaven and filled with God’s glory. Statement Full Support I fully support the Statement as written without mental reservations. SignatureStatement Exceptions I support the Statement except for the area(s) listed and explained below The exceptions represent either disagreements or items for which I have not yet formed an opinion or convictionSignature For Faculty Positions In Valeo Academy Are there any grades that you would prefer not to teach or do not feel qualified to teach? Any subjects?Are you capable of, or willing to teach Bible as a subject to students? Yes No If no, please explain your reservationsDo you have a Teaching Certificate? Yes No If you do not hold a certificate, do you have plans to obtain one? Yes No Why do you want to work in a Christian School?As a Christian Academy, our philosophy and method of education differ from most public schools. Are you willing to undergo any training and take any seminars/classes required to prepare you to teach at Valeo? Yes No Please read the Valeo Academy Philosophy of Education (found on www.valeoacademy.com) and indicate your reaction below CERTIFICATION AND AGREEMENT I understand that Life Changers International Church/Valeo Academy/ Gregory Dickow Ministries (hereafter “LCIC”) does not discriminate in its employment practices against any person because of race, color, sex, age, national or ethnic origin, ancestry, disability, military status or any other protected classification in accordance with applicable federal, state and local laws. I hereby certify that the facts set forth in this initial application are true and complete to the best of my knowledge. I understand that discovery of falsification of any statement or a significant omission of fact may prevent me from being hired, or if hired, may subject me to immediate dismissal regardless of the time elapsed before discovery. If I am released under these circumstances, I further understand that I will be paid and receive benefits only through the day of release. I authorize references and my former employers to disclose to LCIC any and all employment records, performance reviews, letters, reports, and other information related to my suitability for employment, without giving me prior notice of such disclosure. In addition, I hereby release LCIC, my former employers, references, and all other parties from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I waive the right to ever personally view any references given to the school. I understand that I will undergo a background and criminal records check and will be asked to complete an Authorization to Obtain Consumer Report for the purposes of obtaining an investigative consumer report for consideration of employment. I understand and agree that any offer of employment that I may receive from LCIC is conditioned upon the receipt of background information, including criminal background information. I understand that this is only an application for employment and that no employment contract is being offered at this time. I certify that I have carefully read and understand the above statements.Name* First Last Signature*Date* Date Format: MM slash DD slash YYYY
