Instructor Application

Instructor Application
CONTACT INFORMATION
Instructor Name____________________________________
Application Date_____________________________________
Any other name you have used previously: ______________________________________
Permanent Address _________________________________________________________
_________________________________________________________________________
Telephone Number ___________________________________
Email Address ______________________________________________________________
EDUCATION
College/Higher Education/High School
Location
Course of Study
Degrees
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
EMPLOYMENT (List current or most recent job first)
Employer
Dates
Position
Supervisor
Phone #
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
REFERENCES:
1. Name: ________________________________________ Phone: _____________________
Address: ____________________________________________________________________
2. Name: ________________________________________ Phone: _____________________
Address: ____________________________________________________________________
3. Name: ________________________________________ Phone: _____________________
Address: ____________________________________________________________________
Fiddlehead Center for the Arts- Scarborough 226 Gorham Road, Scarborough, Maine 04074
(207) 883-5720
http://fiddleheadscarborough.org/
1 AREAS OF INTEREST Indicate your level of experience for the following subject areas “1” in subjects you can organize and instruct independently
“2” in subjects you can assist or co-instruct.
“3” in subjects have experience or an interest in.
ART ______Tie Dyeing ______Beading ______Clay/Ceramics ______Drawing ______Jewelry Making ______Mixed Media Art ______Nature Crafts ______Painting ______Photography ______Puppet Making ______Sculpture /3D ______Weaving ______Woodworking SCIENCE ______Astronomy ______Biology ______Birds ______Conservation ______Chemistry ______Geology ______Insects ______Marine Biology ______Physics ______Weather/climate ______Wildlife Please list any other activities or skills you think you could lead teach:
____________________________________________________________
TECHNOLOGY ______Film making ______Photography/editing ______Lego Robotics ______Programming ______Stop Animation OTHER SKILLS ______Performance art ______Geography ______US History ______Outdoor skills ______Sign Language ______Cooking ______Music:_________________ ______Foreign Language_________ APPLICATION QUESTIONS: 1. What experience do you have with working with children? Please be specific to what duties and
responsibilities you had and what age group(s) you worked with:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________ 2. What sort of contribution could you make at Fiddlehead Center for the Arts? _______________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________ 3. Describe the leadership or supervisory positions you have had in the past. How will your previous
experiences help you as an instructor?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________ 4. Criminal Record Have you ever been convicted of a crime, including child abuse and sex related
crimes, other than a minor traffic offense? If yes, please elaborate on charges. (Note: a prior conviction is
not an automatic bar to employment.)
______Yes
______ No
Explain________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________ Fiddlehead Center for the Arts- Scarborough 226 Gorham Road, Scarborough, Maine 04074
(207) 883-5720
http://fiddleheadscarborough.org/
2 SCHOOLYEAR AVAILABILITY: Please check off shifts you are available for the schedule below:
SEPTEMBER
TO MID JUNE
Monday
Tuesday
Wednesday
Thursday
Friday
Morning Care
7am to 9am
Afternoon
Care
2:45pm- 6pm
SUMMER AVAILIABLITY Please check all weeks that you will be available this summer.
SUMMER Week 1 Week 2 Week 3 Week 4 Week 5 SCHEDULE June 15-­‐19 June 22-­‐26 6/29-­‐ 7/3 July 6-­‐10 July 13-­‐17 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 July 20-­‐24 July 27-­‐31 August 3-­‐7 Aug 10-­‐24 Aug 17-­‐21 Aug 24-­‐28 SUMMER SHIFTS Please check all available shifts that you will be available this summer.
Monday
Tuesday
Wednesday
Thursday
Friday
Available Shifts
Morning Extended Care
7am to 9am
Morning Camp
9am to 12pm
Afternoon Camp
12pm to 4:30
Afternoon Extended Care
4:30pm- 6pm
I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST
OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS
APPLICATION SHALL BE GROUNDS FOR DISMISSAL.
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED
ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY
OTHER INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE.
IN THE EVENT I AM OFFERED A POSITION I AGREE TO FURNISH MY DOB FOR THE PURPOSE OF A
CRIMINAL RECORDS CHECK. I ALSO UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR
NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY,
BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE AND I UNDERSTAND THAT THIS APPLICATION
IS NOT AN EMPLOYMENT CONTRACT.
SIGNATURE _______________________________________DATE _______________________
Thank you for applying for a position with Fiddlehead Center for the Arts- Scarborough
Please return this application to
Jared Libby
Director of Operations
Fiddlehead Scarborough
226 Gorham Road
Scarborough, Maine 04074
Fiddlehead Center for the Arts- Scarborough 226 Gorham Road, Scarborough, Maine 04074
(207) 883-5720
http://fiddleheadscarborough.org/
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