Staff Application for Quisqueya Christian School
Preparing and Equipping Students to Impact Their World For the Glory of Jesus Christ
Physical Address:
#4 Delmas 75
Delmas, Haiti
Mailing Address:
Unit 2029 – QCS
3170 Airmans Drive
Fort Pierce, FL 34946
U.S.A.
Telephone:
011 (509) 2816-3000
011 (509) 2816-4000
1 (772) 621-5570
Efax:
1 (305) 946-0172
Email:
[email protected]
Website:
www.quisqueya.org
Full Name:
Title First Middle Last
Date of Application:
Position Desired:
e.g., Middle School Science Teacher
Date Available:
A. PERSONAL INFORMATION
1. Basic Details
Personal Email:
2. Birth
Date of Birth:
Personal Phone Number:
Place of Birth:
Social Security Number:
(if applicable)
Driver’s License Number:
Street Address:
Country of Birth:
Nationality:
Street
City, State ZIP Code
Country
3. Marital/Family Status (check all that apply)
Single
Married
Date:
Divorced
Date:
Remarried
Date:
Widowed
Date:
4. Dependents
Name
Age
Grade
Number of Dependents:
Quisqueya Christian School Staff Application (Updated June 2011)
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Staff Application for Quisqueya Christian School
Preparing and Equipping Students to Impact Their World For the Glory of Jesus Christ
5. Health
Height:
6. Church Involvement
Name of church currently attending:
Weight:
What is the general condition of your health?
How many days have been missed for illness in the past
three years?
How often do you attend?
Member?
Church Address:
Street
Yes
No
City, State Zip Code
Country
Do you have any physical disabilities or limitations?
Pastor’s Name:
Pastor’s Email:
Describe any serious illnesses in your health
background.
Church Phone Number:
7. Haiti
Have you ever visited Haiti?
Yes
If yes, what did you do while you were here?
8. Other Countries
What other countries have you visited? What other
cross-cultural experiences have you had?
Church Fax Number:
Describe your involvement at your church.
No
Which languages do you speak?
Native
Fluent
Learning
None
English
French
Creole
Spanish
Other?
B. EDUCATION
9. High School
Name:
Location:
City, State, Country
10. Tertiary Education
Give the details of all courses of studies beyond high school, either in progress or completed. Note that official
transcripts will be required.
Name of Institution
Location
Major(s)
Minor(s)
Certificate
Year
or Degree Earned
City, State, Country
City, State, Country
City, State, Country
Quisqueya Christian School Staff Application (Updated June 2011)
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Staff Application for Quisqueya Christian School
Preparing and Equipping Students to Impact Their World For the Glory of Jesus Christ
11. Professional Certificate(s)
Give the details of any certificates held (i.e. special skills, teaching, computer, counselor, librarian, etc.). Please
send copies of all certificates with this application.
Type
State
Level(s)
Subject or Responsibility
Date of Issue
Expiration Date
12. Biblical Studies
Aside from anything listed above, have you had any courses in Biblical studies (i.e. academic, workshops, etc.)? If
so, please describe area(s) of study, where, and when.
13. Christian Education
Have you had any courses in the Christian Philosophy of Education (dealing with general school subjects)? If so,
please describe area(s) of study, where, and when.
Have you had other courses giving specific training for Christian schools? If so, give schools and details.
14. Practice Teaching (inexperienced teachers only)
Please describe any practice teaching experiences accumulated in the course of your education experience.
15. Contracted Teaching Experience
List your contracted teaching experiences, beginning with the most recent.
Name of School
Location
Grade
Level(s)
Subject(s) Taught
Year
Start
Year
End
City, State, Country
City, State, Country
City, State, Country
City, State, Country
16. Other Experiences
List any specialized teaching, student advisory experiences, or work experiences you have had which enhance your
teaching abilities. Give a short comment on each.
Experience
Description
Comments
e.g. Boy Scout Leader
Camping with 10-year-olds
Enjoyed the experience
Quisqueya Christian School Staff Application (Updated June 2011)
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Staff Application for Quisqueya Christian School
Preparing and Equipping Students to Impact Their World For the Glory of Jesus Christ
C. POSITION DESIRED
17. Grade Level/Subjects
Elementary (Pre-K - 6)
Grades you prefer to teach:
Grades you would accept:
Subject(s) you prefer to teach:
Reasons for preferences:
Middle School (7 - 8)
Grades you prefer to teach:
Subjects you prefer to teach:
Additional subjects you feel prepared to teach if needed:
Reasons for preferences:
High School (9-12)
Subjects you prefer to teach:
Additional subjects you feel prepared to teach if needed:
Reasons for preference:
18. Other School Activities
What additional school activities beyond classroom teaching are you prepared to supervise or assist with?
19. Duration of Appointment
Are you interested in teaching:
Comments:
2 years
3 years
indefinitely
D. PERSONAL OPINIONS
20. Overseas Schooling
Why are you interested in an overseas Christian school, particularly Quisqueya Christian School?
21. Christian Schooling
Have you recognized any leading of the Lord toward Christian school teaching? If so, describe.
State what you consider to be the role and distinctive characteristics of Christian schools.
State how your handling of the subject matter in a Christian school would differ from your handling of it in a
public school.
22. Discipline
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Staff Application for Quisqueya Christian School
Preparing and Equipping Students to Impact Their World For the Glory of Jesus Christ
What is your philosophy of student discipline?
23. Background
Have you ever been accused, convicted of, or pled guilty or “no contest” to any crime?
If yes, please explain:
Yes
No
Have you ever been accused, convicted of, or pled guilty or “no contest” to any kind of sexual, child, or spousal
abuse?
Yes
No
If yes, please explain:
24. Professional Background
Why do you wish to make a change from your present position?
Have you ever been fired from a position or voluntarily terminated a contract?
If yes, please explain:
Yes
No
25. Signature
I hereby sign that the information I have provided on this application is true to the best of my knowledge.
Signature:
Date:
E. REFERENCES
Name
Address
A spiritual leader
Street, City, State ZIP,
Country
A direct supervisor in
a job, church or
teaching position
Street, City, State ZIP,
Country
A teaching supervisor
Street, City, State ZIP,
Country
A teacher who has
taught with you
Street, City, State ZIP,
Country
A friend who has
known you for many
years (not a relative)
Street, City, State ZIP,
Country
Others you wish us to
contact
Street, City, State ZIP,
Country
Quisqueya Christian School Staff Application (Updated June 2011)
Phone
E-mail
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Staff Application for Quisqueya Christian School
Preparing and Equipping Students to Impact Their World For the Glory of Jesus Christ
F. DOCTRINAL STATEMENT
1.
2.
3.
4.
5.
6.
7.
We believe in the verbal inspiration of the Bible, equally in all its parts, and without error in its origin; the only
infallible rule of faith and practice.
We believe in the one God, eternally existent in three persons, Father, Son, and Holy Spirit, who created man
by a direct immediate act.
We believe in the Deity of Jesus Christ, His pre-existence, incarnation, Virgin birth, sinless life, substitutionary
death through His shed blood, bodily resurrection and ascension to the right hand of the Father, and His
personal return.
We believe that the whole human race fell into sin in Adam, the head and progenitor of mankind, and that
because of sin, man is depraved and in need of individual salvation by grace alone, through faith in the shed
blood of the Lord Jesus Christ.
We believe in the reality and personality of Satan, the enemy of God and man.
We believe in the resurrection of the saved and the lost; they that are saved unto eternal blessedness in
God’s presence, and they that are lost unto eternal damnation in the Lake of Fire.
We believe in the spiritual unity of all believers in the Lord Jesus Christ, growing daily in grace and knowledge
of the Lord, constantly being filled with the Holy Spirit who indwells every believer, separated from worldly
practices and attitudes, and giving witness of His saving grace.
This is the statement of faith of our school. If it is a statement of your basic Christian convictions also, please
indicate this by your signature. If on any point you disagree or have mental reservations, please state your
viewpoint below.
Signature:
Date:
Thank you! If possible, please also attach a recent photograph of yourself. We are looking forward to receiving
your application.
Quisqueya Christian School Staff Application (Updated June 2011)
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