Instructor Application
Transcription
Instructor Application
Instructor Application CONTACT INFORMATION Instructor Name____________________________________ Application Date_____________________________________ Any other name you have used previously: ______________________________________ Permanent Address _________________________________________________________ _________________________________________________________________________ Telephone Number ___________________________________ Email Address ______________________________________________________________ EDUCATION College/Higher Education/High School Location Course of Study Degrees ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ EMPLOYMENT (List current or most recent job first) Employer Dates Position Supervisor Phone # ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ REFERENCES: 1. Name: ________________________________________ Phone: _____________________ Address: ____________________________________________________________________ 2. Name: ________________________________________ Phone: _____________________ Address: ____________________________________________________________________ 3. Name: ________________________________________ Phone: _____________________ Address: ____________________________________________________________________ Fiddlehead Center for the Arts- Scarborough 226 Gorham Road, Scarborough, Maine 04074 (207) 883-5720 http://fiddleheadscarborough.org/ 1 AREAS OF INTEREST Indicate your level of experience for the following subject areas “1” in subjects you can organize and instruct independently “2” in subjects you can assist or co-instruct. “3” in subjects have experience or an interest in. ART ______Tie Dyeing ______Beading ______Clay/Ceramics ______Drawing ______Jewelry Making ______Mixed Media Art ______Nature Crafts ______Painting ______Photography ______Puppet Making ______Sculpture /3D ______Weaving ______Woodworking SCIENCE ______Astronomy ______Biology ______Birds ______Conservation ______Chemistry ______Geology ______Insects ______Marine Biology ______Physics ______Weather/climate ______Wildlife Please list any other activities or skills you think you could lead teach: ____________________________________________________________ TECHNOLOGY ______Film making ______Photography/editing ______Lego Robotics ______Programming ______Stop Animation OTHER SKILLS ______Performance art ______Geography ______US History ______Outdoor skills ______Sign Language ______Cooking ______Music:_________________ ______Foreign Language_________ APPLICATION QUESTIONS: 1. What experience do you have with working with children? Please be specific to what duties and responsibilities you had and what age group(s) you worked with: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 2. What sort of contribution could you make at Fiddlehead Center for the Arts? _______________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. Describe the leadership or supervisory positions you have had in the past. How will your previous experiences help you as an instructor? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. Criminal Record Have you ever been convicted of a crime, including child abuse and sex related crimes, other than a minor traffic offense? If yes, please elaborate on charges. (Note: a prior conviction is not an automatic bar to employment.) ______Yes ______ No Explain________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Fiddlehead Center for the Arts- Scarborough 226 Gorham Road, Scarborough, Maine 04074 (207) 883-5720 http://fiddleheadscarborough.org/ 2 SCHOOLYEAR AVAILABILITY: Please check off shifts you are available for the schedule below: SEPTEMBER TO MID JUNE Monday Tuesday Wednesday Thursday Friday Morning Care 7am to 9am Afternoon Care 2:45pm- 6pm SUMMER AVAILIABLITY Please check all weeks that you will be available this summer. SUMMER Week 1 Week 2 Week 3 Week 4 Week 5 SCHEDULE June 15-‐19 June 22-‐26 6/29-‐ 7/3 July 6-‐10 July 13-‐17 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 July 20-‐24 July 27-‐31 August 3-‐7 Aug 10-‐24 Aug 17-‐21 Aug 24-‐28 SUMMER SHIFTS Please check all available shifts that you will be available this summer. Monday Tuesday Wednesday Thursday Friday Available Shifts Morning Extended Care 7am to 9am Morning Camp 9am to 12pm Afternoon Camp 12pm to 4:30 Afternoon Extended Care 4:30pm- 6pm I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY OTHER INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE. IN THE EVENT I AM OFFERED A POSITION I AGREE TO FURNISH MY DOB FOR THE PURPOSE OF A CRIMINAL RECORDS CHECK. I ALSO UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE AND I UNDERSTAND THAT THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT. SIGNATURE _______________________________________DATE _______________________ Thank you for applying for a position with Fiddlehead Center for the Arts- Scarborough Please return this application to Jared Libby Director of Operations Fiddlehead Scarborough 226 Gorham Road Scarborough, Maine 04074 Fiddlehead Center for the Arts- Scarborough 226 Gorham Road, Scarborough, Maine 04074 (207) 883-5720 http://fiddleheadscarborough.org/ 3