Level:
Elementary Secondary

First Name: Last Name:

Middle Name:

Email Address

Mailing Address

City: State:

Zip

Preferred Contact Number

Religious Affiliation

Parish Parish City

Religious Community

U.S Citizen? Can you work in the U.S?

Do you have administrator certification? Yes No

Certification type: Certificating State?

Do you have teacher certification Yes No

Certification type: Certificating State?

Yes, I do have an Advanced Degree

Academic and Professional Training

Level of Education	Name of Institution, City, State	Areas of Concentration (Major Minor)	Degree or Certificate
Secondary School	State:
Undergraduate College / University	State:
Graduate Program	State:
Other	State:

Educational Work Experience

TEACHING EXPERIENCE: (Include last three schools, beginning with most recent)

School, City & State	Dates: mm/dd/yyyy
State:	From:	to:
State:	From:	to:
State:	From:	to:

Administrative or Supervisory Experience

(List most recent first)

School, City & State	Dates: mm/dd/yyyy
State:	From:	to:
State:	From:	to:
State:	From:	to:

Non-Educational Work Experience

Position	Employer / Address	Dates: mm/dd/yyyy
		From:	to:
		From:	to:
		From:	to:

Memberships

Organization

References

Name	Title / Relationship	Address / City / State / Phone
		State:
		State:
		State:

Teaching Preferences

Please list grade levels in order of preference and indicate the subject areas for which you have specialized training. (i.e., PreK, K-6, 6-8, 9-12)

	Grade Levels	Subject Areas (Grades 6-12)
1st Preference
2nd Preference
3rd Preference

1. Please write a statement indicating your understanding of the purpose of a Catholic school education, your personal qualifications for employment in a Catholic school, as well as how your experiences will help advance the Archdiocesan Purpose and Vision for Catholic School Education. (500 word maximum)

Total word count: 0 words. Words left: 500

2. Please write a statement describing your familiarity with instructional technology and its uses in education. Include your understanding of 21st century fluencies and their impact on student college and career readiness. (500 word maximum)

Total word count: 0 words. Words left: 500

Your application will not be considered complete without these two personal statements and your pastor’s approval form.

Verification/Authorization (All Applicants)

The Archdiocese of Hartford requires responses by applicants for employment to the following two questions:

1. Have you ever been dismissed for cause from a position in a public or private school or child-care facility? Yes No
2. Have you ever had a teaching credential revoked, suspended or annulled in any state, territory or foreign country? Yes No

If you answered "yes" to any of the above questions, please write a statement of explanation in the box provided.

Verification and Authorization

I certify that all of the information provided by me on this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize any person, school, current and former employer, reference, reporting agency, or any other organization or agency to provide information relevant to schools of the Archdiocese of Hartford and their investigations into any statements I have made on my application or any other matters relating to my background and qualifications. I hereby give the Office of Education, Evangelization and Catechesis’ representatives, local school representatives of the Archdiocese of Hartford, and/or search committee members the right to make a thorough investigation into my previous employment, education and references, and I release from all liability all persons, companies and corporations supplying such information. I also release, indemnify and hold harmless schools and or parishes of the Archdiocese of Hartford from and against any and all liability which might result from making such an investigation.

I authorize the Office of Education, Evangelization and Catechesis for the Archdiocese of Hartford to release any enclosed or attached documents that will facilitate employment in any of the Catholic schools in the Archdiocese of Hartford. I understand that my signature on this form absolves and releases the Archdiocese of Hartford from liability, and agree to indemnify it for any attorney fees in connection with any and all legal action involving the relinquishment of this personal information.

If offered a full-time teaching position, with the exception of a full-time high school religion teacher or campus minister position, I agree to participate in the required adult faith formation program. If offered an administration position, I agree to participate in the Catholic Leadership Program if required.

Agree

*By checking this box, I agree to the terms stated above in the Verification and Authorization section.

Application for Teacher Positions