1. Instructor Information

  2. First Name(*)
    Please enter your first name.
  3. Last Name(*)
    Please enter your last name.
  4. Middle Initial
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  5. Street Address Line 1(*)
    Please enter your street address.
  6. Street Address Line 2
  7. City(*)
    Please enter your city.
  8. State(*)
    Please enter your state.
  9. Zip Code(*)
    Please enter your zip code.
  10. Home Phone(*)
    Please enter your phone number 123-123-1234.
  11. Cell Phone or Pager
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  12. Email Address(*)
    Please enter an email address.
  13. Position You Are Applying For
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  14. Date Available
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  15. Emergency Contact(*)
    Please enter an emergency contact.
  16. Are you a citizen of the United States?
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  17. If no, are you authorized to work in the United States?
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  18. Have you ever worked for EIAA?
    Have you worked
  19. If yes, when?
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  20. Have you ever been convicted of a felony?
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  21. If yes, explain:
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  22. Are you on the sex offender registry?
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  23. If yes, explain:
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  24. Education

  25. High School
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  26. High School Address
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  27. Date Started (MM/DD/YYYY)
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  28. Date Finished High School (MM/DD/YYYY)
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  29. Did you graduate?
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  30. High School Degree (if any)
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  31. College
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  32. College Address
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  33. Date Started College (MM/DD/YYYY)
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  34. Date Finished College (MM/DD/YYYY)
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  35. Did you graduate?
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  36. College Degree
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  37. Do you have a teaching license?
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  38. Teaching License Area?
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  39. List other Certifications:
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  40. Honors or Awards:
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  41. Artistic Strengths/Background:
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  42. Please list 2 Professional References

  43. Reference Name
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  44. Relationship
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  45. Company or Business Name
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  46. Phone
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  47. Address
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  48. Reference Name
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  49. Relationship
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  50. Company or Business Name
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  51. Phone
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  52. Address
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  53. Previous Employers

  54. Employer 1 Business or Company
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  55. Address
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  56. Phone
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  57. Supervisor
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  58. Job Title
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  59. Responsibilities
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  60. Date Started (MM/DD/YYYY)
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  61. Date Finished (MM/DD/YYYY)
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  62. Reason for Leaving
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  63. May we contact your previous supervisor for a reference?
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  64. Employer 2 Business or Company
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  65. Address
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  66. Phone
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  67. Supervisor
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  68. Job Title
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  69. Responsibilities
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  70. Date Started (MM/DD/YYYY)
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  71. Date Finished (MM/DD/YYYY)
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  72. Reason for Leaving
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  73. May we contact your previous supervisor for a reference?
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  74. Disclaimer and Signature

  75. I certify that my answers are true, accurate and complete to the best of my knowledge. I authorize all current and former employers to release any information concerning my background. I understand that this application is not a contract of employment. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
  76. Digital Signature(*)
    Please enter your name for your digital signature.
  77. Date (MM/DD/YYYY) (*)
    Please enter the date for the digital signature.
  78. Background Check

  79. Employment is contingent upon a criminal background investigation. EAA will conduct a background check to determine or verify background information. Having a criminal history or criminal conviction does not necessarily preclude an individual from employment. Review by the EAA board will occur on a case-by case basis.
  80. Digital Signature (*)
    Please enter your name for your digital signature.
  81. Date (MM/DD/YYYY) (*)
    Please enter the date for your digital signature.
  82. Teacher Agreement

  83. Download the Teacher Agreement
  84. I have received and reviewed the Teacher Agreement.
  85. Digital Signature(*)
    Please enter your name for your digital signature.
  86. Date (MM/DD/YYYY) (*)
    Please enter your name for your digital signature.
  87. Nondiscrimination Policy

  88. Eastern Iowa Arts Academy does not discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, national origin, religion, or disability in any program or activity.

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