Legal Name
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First Name
Last Name
Email
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
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(###)
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Have you taught before? How many years?
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Are you currently teaching?
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How long are you willing to commit to teaching at Medina School of Music?
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Best way to contact you?
What interests you about this position?
What obligations do you have that may interrupt your weekly teaching schedule? - such as gigs, recording commitments, touring, etc
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Date Available to Start
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MM
DD
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Name of the employee who referred you, or how did you hear about us?
Are you a citizen of the United States?
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If no, are you authorized to work in the United States?
Have you every been convicted of a felony?
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If yes, please explain
High School
Did you graduate High School?
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College (Undergraduate)
From
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To
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Did you graduate college (Undergraduate)?
College (Highest Degree Attained)
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To
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Highest Degree Attained?
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Full Name - Reference #1
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First Name
Last Name
Relationship - Reference #1
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Phone - Reference #1
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(###)
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Full Name - Reference #2
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First Name
Last Name
Relationship - Reference #2
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Phone - Reference #2
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(###)
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Company 1 (Most recent or current)
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Company Phone
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(###)
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Supervisor Name
First Name
Last Name
Job Title
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From
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MM
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To
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MM
DD
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Reason for leaving
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Company 2
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Company Phone
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(###)
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Supervisor Name
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First Name
Last Name
Job Title
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From
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MM
DD
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To
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MM
DD
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Reason for leaving
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Company 3
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Company Phone
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(###)
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Supervisor Name
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First Name
Last Name
From
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MM
DD
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To
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MM
DD
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Reason for leaving
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Musical Experience
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Teaching Experience
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Primary instruments you teach
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Secondary instruments (optional)
Check which level(s) you feel comfortable teaching
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Check which age(s) you feel comfortable teaching
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Check which days you are available to teach
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I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment.
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I understand, where permissible under applicable state and local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment, and must receive a negative result for illegal drugs before being permitted to commence work with Medina School of Music.
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I understand, where permissible under applicable state and local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with Medina School of Music.
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I hereby certify that the information given by me is true in all respects. I authorize Medina School of Music and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools, and other persons named on this application to provide any information or transcripts requested.
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I understand employment with Medina School of Music is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.
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I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause, by either party (Medina School of Music or me) without prior notice to the other, unless otherwise prohibited by law.
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I understand that no representation, whether oral or written, by any representative or agent of Medina School of Music, at any time, can constitute an implied or expressed contract of employment. I further understand no representative or agent of Medina School of Music has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by the Director of Human Resources or an authorized representative.
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I certify, under penalty of perjury, that all of the above information is true and complete, and I understand that any falsification or omission of information may result in denial of employment or, if hired, may result in termination regardless of the time lapse before discovery. Note: An offer of employment is conditioned upon complying with Medina School of Music’s requirements including, but not limited to, signing a consent to conduct a background investigation. MY DIGITAL SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.
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Today's Date
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MM
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