Caldwell AcademyCOLLEGE ADMISSIONS COUNSELOR
2900 Horse Pen Creek Road APPLICATION FORM
Greensboro, NC 27410
336-665-1161
Thank you for your interest in an administrative position at Office Use
Caldwell Academy. If you have read our handbook and Date Rcvd
Dorothy Sayers’ essay The Lost Tools of Learning and have Action Taken
substantial agreement with the vision outlined, then please
complete and return this application form. The administrator
will contact you regarding the status of your application.
(Please Type or Print)
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I. Personal Information
Name:______Social Security Number______
Last First Middle
Address: ______
Street City State Zip
Phone: (Home)______(Work)______(Cell)______
Name of your church: ______Are you a member? yes no
Are you a United States Citizen? yes no Email address: ______
Prior residences during the last ten years:
City and State Dates of Residency
Date you would be available for employment: ______
II. Christian Background and View
Do you agree with the Caldwell Academy Statement of Faith? If not, please explain.______
In what church are you currently a member? ______
Does your church agree with CaldwellAcademy’s Statement of Faith? ______
Please answer the following questions, using additional pages as necessary:
Please describe how you serve your church and community. ______
Please briefly describe your relationship with Jesus Christ including your salvation experience and Christian growth. ______
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Please briefly explain how your relationship to Christ impacts your lifestyle. ______
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Please briefly explain how a Christian worldview would impact how you function as an administrator.
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Please describe your working relationship with high school students and parents.
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Please describe life and work experiences that have prepared you for this position at Caldwell Academy.
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III. Educational Background and Experience
Academic Preparation:
Name of college Dates Attended Degree Major and Minor
Please list other academic training relevant to education and administration. ______
Education/Administration Experience:
Name of Organization Dates Grade(s) Subject(s)
Please list other experience relevant to administration. ______
Teaching/Administration Certification:
Type of Certificate Area(s) of certification Expiration Date
Please list any special talents and abilities related to administration. ______
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How long would you like to work at Caldwell Academy? ______
IV. References
Have you ever been charged with child abuse? yes no
Have you ever been arrested? yes no
If “yes”, when? ______Were you convicted? yes no
Please give details of the arrest/conviction. ______
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Do we have permission to do background checks with national, state and local agencies (this is required of all employees)? yes no ______
Signature
Please provide names, addresses, and phone numbers for the following references:
Your pastor: ______
A supervisor: ______
A co-worker: ______
Do we have permission to contact your references? yes no ______