For Office Use Only:
________ Date Received		___________ Interview Date
________ Transcript Received 	___________ 2nd Interview Date
________ References Checked	___________ Code of Conduct
________ Credentials Checked	___________ Background Check Forms
________ Certificate Verified	___________ TB Test Result
________ Status Notification 	___________ Board Approval

EMPLOYMENT APPLICATION

Your interest in Tri-State Christian School is appreciated. We invite you to fill out this initial application and return it to our school office. If we have continued interest in your candidacy, we will send you some follow up questions, contact your references, and arrange for a personal interview.

We realize that the key to a successful Christian School is its faculty and staff. We are seeking applicants who are professionally qualified, who really love children, and who, by the pattern of their lives, are Christian role models. Luke 6:40.

We look forward to receiving your initial application. Thank you for your interest in the ministry of our school. It is our prayer that God will fulfill His perfect will in the lives of all applicants.

A.	APPLICANT'S NAME AND ADDRESS
                                                                                         
Full name: 	

Application date: 		/	/	 Date available: 	__	/__	____/_______

Present address: 	_

Email Address:________________________________________________________________

Phone: Days (		)	 Evenings (	)________________

Best time to call you? 	______________ Length of time at this address? ___________________
Permanent address and phone number if different than present address

Please list any additional addresses where you have resided at any time during the past 
five years:
	______
___	

B. POSITION DESIRED

Position Desired: ______________________________________________________________

How did you learn about the position for which you are applying?

	____

Can you submit verification of your legal right to work in the US?                         Yes ___ No ___

Please list activities or sports for which you would be capable and willing to direct, sponsor, or coach. (Indicate grade or ability levels.)
	
What would you like to be doing five years from now?

C. CHRISTIAN BACKGROUND

* On separate paper, briefly give your Christian testimony.

Please carefully read our Statement of Faith and indicate your degree of support.

___ I fully support the Statement as written without mental reservations. 

___ I support the Statement except for the area(s) listed and explained on a separate paper. The exceptions represent either disagreements or items for which I have not yet formed an opinion or conviction. 

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 ____

Are you certain that you have eternal life?                Yes ____        No ____

If you were to die today and stand before God and He asked you, “Why should I let you into My heaven?” what would you say? ___________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Denominational preference? 	

Name and location of local church that you attend: 	____
____________________________________________________________________________
Are you presently a member in good standing?  __________________            Years? ________
With what regularity have you attended during the past twelve months? ___________________

In what church activities are you involved and with what degree of regularity? 

Describe your routine of personal Bible study and prayer.  ______________________________
	
What books have you read recently that have helped you spiritually?
	
If you become employed by our school, you are joining a ministry that has high expectations of all its employees. All employees are in ministry and must demonstrate the life of Christ in their everyday living to our students, their parents, and fellow employees. Since it is the school’s mission to train and equip children to be followers of Jesus Christ, we require all of our employees to be Christian role models in their lives, both on and off the job (Luke 6:40). Please carefully read the school’s Professional Code of Conduct (see attached). If you can honestly sign this form, please do so.

D. PROFESSIONAL QUALIFICATIONS

* Please attach photocopies of all your postsecondary transcripts. Should you be offered a position, official copies of your transcripts must be provided to the school for inclusion in your personnel file.

	Names & Locations of School(s) Attended	Date Graduated	
Secondary School(s)			
			
	Name & Location of Institution(s) Attended	Date & Degree	
Colleges
or
Universities			

			

Cumulative grade point average Bachelor’s ___________ Graduate work ___________
Total college credits earned after date of Bachelor's degree: __________
Are you capable of teaching a Bible class? ___ If yes, what would be your subject preferences?
	
List any Bible courses/degrees or formal Bible training you have had: _____________________ ____________________________________________________________________________
Sequentially list your teaching experience with most recent first.

School's Name  	        Position                                         Dates

	

	

To what degree are you familiar with various Christian or secular textbook series (e.g., ACSI, ABeka, Bob Jones, Saxon math, Open Court Reading)?

List any books or articles that you have read recently that have helped you to grow professionally. 	
Describe your level of computer/technology skills:_____________________________________
 ____________________________________________________________________________
Do you have an ACSI Teaching Certificate? 	

What level? 	__________ Remains valid for ___________ years.

Do you have a state teaching certificate? 	 State? _____________	

What kind? 	______	 Remains valid for 		 years.

Endorsement(s)		List semester hours in endorsement area(s)

If you do not hold a certificate, what requirements do you lack?
	
* Please attach photocopies of any certificates held.

Have you had any courses in the Christian Philosophy of Education? If so, where and when? 
____________________________________________________________________________
If not, would you be willing to take such a course by correspondence or otherwise? __	

* Attach a typed copy of your personal Christian philosophy of education and how you would implement it in the classroom.

E. PERSONAL PHILOSOPHY

* On separate paper please label and succinctly answer in one or two paragraphs each of the questions below.

A. What are the main characteristics that distinguish a Christian program from a secular program? 

B. What is your philosophy of discipline and classroom management? 

C. What areas do you feel are your strengths? Weaknesses?

D. What do you believe about the origin of the earth and mankind?

E. Please summarize any additional information that you would like to present regarding your candidacy for this position.

F. EMPLOYMENT HISTORY

Please start with your current or most recent employer and work backwards for the past ten years. If necessary, you may follow the same format on the reverse.

1. Position 	 Dates of Employment 	
Name of Company________________________________________________________
Address 	
	
Supervisor's Name and Phone Number 	
Reason for leaving 	

	

2. Position 	 Dates of Employment 	
Name of Company________________________________________________________
Address 	
	
Supervisor's Name and Phone Number 	
Reason for leaving 	

3. Position 	 Dates of Employment 	
Name of Company________________________________________________________
Address 	
	
Supervisor's Name and Phone Number 	
Reason for leaving 	

Have you ever worked under a different name for any of the employers you have listed? 
If so, what was the name or names?

Have you served in the military? Yes ___ No ___. If yes, what type of training or education did you receive?
____________________________________________________________________________

Are you holding or have you already signed a contract for next year with any other educational institution? Yes ___ No ___

G. PERSONAL REFERENCES

Do not list family members or relatives for references. You will also need to sign the Reference Release Form that is attached and return it with this application. 

Give three references who are qualified to speak of your spiritual experience and Christian service. List your current pastor first.

Name/Complete Address		Phone			Position

1. 	

2.	

3.	

Give three references who are qualified to speak of your professional training and experience. List your current or most recent principal or supervisor first.

Name/Complete Address		Phone			Position

1.	

2.	

3.	

H. APPLICANT'S CERTIFICATION AND AGREEMENT

Have you ever been convicted of a criminal offense (felony or misdemeanor, expect for minor traffic violations)? You will need to answer yes if you have entered into a plea agreement, including a postponed sentence or postponed judgment arrangement, in connection with a criminal charge. (You need not disclose criminal convictions that are contained in sealed or deleted records.)  Yes/No______________

If you have been convicted of such an offense, please attach a statement of explanation, including the nature of offense, date, court where conviction was entered, and any other relevant information. A conviction record will not automatically be a bar to employment. Factors such as your age at the time of the crime, seriousness and nature of the violation, time elapsed since the crime, job-relatedness, and subsequent rehabilitation will be considered.

Has any employer ever subjected you to disciplinary action, suspension, or termination or asked you to leave a paid or unpaid position on the grounds of any unlawful sexual behavior or violation of an employer’s sexual misconduct policy or anti-harassment policy? Yes/No _______________ If yes, please attach a statement of explanation.

Have you ever resigned a position to avoid termination or discharge? Yes/No _______________
If yes, please attach a statement of explanation.

I understand that Tri-State Christian School does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, gender, age, or qualified disability.

I hereby certify that the facts set forth in this application process are true and complete to the best of my knowledge. I understand that 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 and agree that I will be paid and receive benefits only through the day of release.

Since I will be working with children, I understand that I must submit to a fingerprint check by the FBI and possibly other federal and state authorities. I agree to fully cooperate in providing and recording as many sets of my fingerprints as are necessary for such an investigation. I authorize the school to conduct a criminal records check. I understand and agree that any offer of employment that I may receive from the school is conditioned upon the receipt of background information, including criminal background information. The school may refuse employment or terminate conditional employment if the school deems any background information unfavorable or that it could reflect adversely on the school or on me as a Christian role model.  

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 do understand the above statements.

Applicant’s Signature			Date

AUTHORIZATION TO RELEASE REFERENCE INFORMATION

I have made application for a position as a ________________________________ with Tri-State Christian School. I have authorized the school to thoroughly interview the primary references which I have listed, any secondary references mentioned through interviews with primary references, or other individuals that know me and have knowledge regarding my testimony and work record. I also authorize the school to thoroughly investigate my work records and evaluations, my educational preparation, and all other matters related to my suitability for employment.

I authorize references and my former employers to disclose to the school any and all employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure.

In addition, I hereby release the Tri-State Christian School, 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 Tri-State Christian School.

I agree that a photocopy or facsimile copy of this document and any signature shall be considered for all purposes as the original signed release on file.  

I certify that I have carefully read and do understand the above statements.

	
Applicant's Signature							Date

Applicant's Social Security Number

STATEMENT OF FAITH

•	We believe in the Bible, both the Old and the New Testaments as verbally inspired by God and inerrant in the original writing, and that it is of supreme and final authority in faith and life.
•	We believe in one God, eternally existing in three Persons: Father, Son and Holy Spirit.
•	We believe that Jesus Christ was begotten by the Holy Spirit, born of the Virgin Mary, and is true God and true man.
•	We believe that man was created in the image of God; that he sinned, and thereby incurred not only physical death, but also spiritual death, which is separation from God; and that all human beings are born with sinful nature, and, in the case of those who reach moral responsibility, become sinners in thought, word and deed.
•	We believe that the Lord Jesus Christ died for our sins, according to the Scriptures, as a representative and substitutionary sacrifice; and that all who believe in Him are justified on the grounds of His shed blood.
•	We believe in the resurrection of the crucified body of our Lord, in His ascension into Heaven, and in His present life there for us, as High Priest and Advocate.
•	We believe in “that blessed hope”, the personal and imminent return of our Lord and Savior, Jesus Christ.
•	We believe that all who receive by faith the Lord Jesus Christ are born again of the Holy Spirit, and thereby become children of God.
•	We believe in the bodily resurrection of the just and the unjust, the everlasting blessedness of the saved and the everlasting punishment of the lost.
•	We believe in the spiritual unity of all believers under the headship of Jesus Christ.

I have read and agree with the Statement of Faith of Tri-State Christian School.

Applicant's Signature							Date

6/9/14 TN/kh

PROFESSIONAL CODE OF CONDUCT

Because Tri-State Christian School is committed to the teachings and principles of the Bible, its Personnel (for the purposes of this Code, Personnel means the Board of Directors, Administration, Faculty, and Staff) must be held to a higher standard of conduct. Since all TSCS personnel serve as Christian role models before the TSCS student body, it should be understood that there must be a direct relationship between what TSCS Personnel believe and the way that TSCS Personnel behave. While it is hoped that TSCS personnel will voluntarily refrain from any illegal, unethical, or immoral act that would bring disgrace to their fellow workers, embarrassment to the school, or reproach to the name of the Lord Jesus Christ, employment/service at TSCS is undergirded by the admonition to conduct oneself in accord with the teachings of Jesus Christ, to abide by rules relating to Christian behavior, and to subscribe to the Mission Statement, Vision Statement, and Statement of Faith as a condition of service. 

The tenets contained in the Professional Code of Conduct are intended to define the high behavioral standards that can reasonably be expected when parents entrust their children to leaders of a Christian school. Moral misconduct, which violates the bona fide occupational qualification for employees to be Christian role models, includes, but is not limited to, promiscuity, homosexual behavior, or any other violation of the unique roles of males and females (Romans 1:21–27, 1 Corinthians 6:9–20). TSCS believes that biblical marriage is limited to a covenant relationship between a man and a woman (Mark 10:6-9).

TSCS personnel will: 
•	not engage in acts of immorality (e.g., adultery, fornication, homosexuality or other acts of sexual perversion) [1 Corinthians 6:9-10, Hebrews 12:16]. 
•	not engage in acts of profanity or obscenity, either in word or deed [Matthew 15:18-19, Ephesians 4:29]. 
•	not use, sell, or distribute illegal drugs or abuse prescription drugs [Romans 13:1-2, 1 Corinthians 6:19]. 
•	not use tobacco or consume alcohol at any school-related function, regardless of his/her personal beliefs or preference, or will not assert his/her “liberty” to partake of these substances when it is probable that a member of the Tri-State Christian School community, perhaps holding contrary views, would resent and be offended [Ephesians 5:18, 1 Corinthians 8:9]. 
•	not frequent establishments of questionable moral/ethical reputation, to include places where gambling, “adult entertainment,” or other places where the propriety of attendance would be questioned of one who is serving as a Christian role model to children [1 John 2:16, 1 Corinthians 15:33]. 
•	not initiate a divorce proceeding against his/her spouse except for reasons of adultery or abandonment, or remarry unless consistent with Scriptural principles [Matthew 5:32, 1 Corinthians 7:10-15]. 
•	not directly or indirectly counsel, cause, or facilitate the abortion of a preborn baby unless, in the opinion of a doctor who is not primarily in the business of performing abortions, such a procedure is necessary to save the life of the mother [Jeremiah 1:5, Psalm 139:13-16]. 
•	not, either as an individual or as a member of a group, engage in activities which might be viewed as divisive, professionally or ethically questionable, or harmful to the ministry of the school, including participating in any groups or organizations whose beliefs are contrary to the Mission Statement of TSCS, Vision Statement of TSCS, or the Statement of Faith of TSCS [Romans 15:5, 1 Corinthians 1:10]. 

Violation of any provision on the Professional Code of Conduct will jeopardize the employment or volunteer relationship and may result in censure, probation, or termination. 

I have read, understand, and agree to abide by the provisions of this Professional Code of Conduct. 

Applicant's Signature 									Date