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Diocese of Covington - Education at 1125 Madison Ave., Covington, KY 41011-3115 US - Job Application Form

Job Application Form

Check One: New Applicant Applied Previously
  Former Employee Present Staff Member
Date of Application:  
Last Name: First Name:
Middle Name: Maiden Name:
Social Security:   
Street Address:   
City, State Zip:   
Telephone #:   
E-Mail Address:   
Verity E-Mail:   

United States Citizen?
Yes No
If you are not a citizen of the United States please mail details of your eligibility for employment in the U.S.
Have you ever been convicted of violating any law (except minor
traffic violations)?
Yes No
If "yes", separately mail a listing of all convictions showing offense, where convicted, and
date of conviction. Disclosure of a criminal record may not automatically disqualify you from
employment consideration.
Have you ever had a teaching certificate revoked or suspended
for any reason?
Yes No
If "yes", please mail an explanation.
As defined under the American's with Disabilities Act, do you
require any "reasonable accommodation" in order to perform
the job for which you have applied?
Yes No

Grade Preference:
Assignment Preference: Full Time   Part Time   Substitute 
Subject Preference:   
Can you coach athletics, direct music or
dramatics, sponsor clubs or participate in   
any other activities? Please specify.:

(Also indicate certificates for which you will become eligible)
Code From
Date Effective
Expiration Date

Diocesan Religious Certification
Diocese: Type:

Degree or Semester
Hours Completed
Year(s) Attended

Year(s) Taught
Grade(s) Taught

Please respond to the questions below briefly and candidly.
Your response will help to better understand the strengths you
can bring to the teaching profession in general and to our
system in particular.

1. What do you want to accomplish as a teacher?
2. How will (do) you go about finding out students' attitudes
and feelings about your class?
3. An experienced teacher offers you the following advice:
When you are teaching, be sure to command the respect of
your students immediately and all will go well. How do you
feel about this?
4. How do you go about deciding what it is that should be
taught in your class?
5. A parent comes to you and complains that what you are
teaching his child is irrelevant to the child's needs. How would
you respond?
6. What do you think will (does) provide you with the greatest
pleasure in teaching?
7. When you have some free time, what do you enjoy doing
the most?
8. How do you go about finding what students are good at?
9. Would you rather try a lot of new teaching strategies or
would you rather try to prefect the approaches which work
best for you? Explain your views.
10. Do you like to teach with an overall plan in mind for the
year, or would you rather just teach some interesting things
that let the process determine results? Explain your position.
11. A student is doing poorly in your class.You talk to her and
she tells you that she considers you to be the poorest teacher
she has ever met. What would you do?
12. If there were absolutely no restrictions placed upon you,
what would you want to do in life?
Date that you can begin teaching:
Additional Comments:





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