Application for Professional Employment

Teacher/Principal
Catholic Diocese of Springfield in Illinois
The Catholic Pastoral Center, parish, school or agency to which you are applying appreciates your willingness to share your
faith, gifts and skills. Providing safe and secure environment for our members is important to us. The information gathered
in this application is designed to help us provide the highest quality Catholic programs for the people of our community.
Thank you for your interest in employment with the Diocese of Springfield in Illinois. Please read the statements below,
date and sign.

I understand and agree that:

1. Any material misrepresentation or deliberate omission of facts on my application will be justification for
refusal of employment, or if employed, termination from employment.

2. If requested by those in authority I agree to submit to search of my person, any locker that may be assigned to
me, any coats, handbags or packages, and waive all claims for damages as a result of such examination.

3. If a contingent offer of employment is made to me, I authorize any physician or hospital to release any
information which may be necessary to determine my ability to perform the essential duties of a job I am being considered
for prior to employment or in the future during my employment. Provided state law permits, I further agree to submit to
alcohol and/or drug screening tests if requested of me at any time prior to or during my employment.

4. I hereby authorize the parish, school, agency or institution, in the Diocese of Springfield in Illinois, where I am
applying may now, or at any time while employed conduct a thorough investigation of my entire work history and may
verify all data given in my application for employment, related papers or oral interviews and obtain additional information
relating to my background. I authorize all schools, companies, corporations, law enforcement agencies to supply
information concerning my background including but not limited to criminal records, motor vehicle records, education and
employment verification, (past and present), reference checks and military service verification. I specifically waive written
notice of such disclosures from my former employers. I understand that falsification of data so given or other derogatory
information discovered as a result of this investigation may prevent my being hired, or if hired, may subject me to
immediate dismissal.

5. I agree to observe all of the guidelines and policies for the parish, school, agency or institution in the Diocese of
Springfield in Illinois where I am applying.

6. I understand that the parish, school, agency or institution in the Diocese of Springfield in Illinois has a zero
tolerance for abuse and takes all allegations of physical or sexual abuse seriously. I further understand that the parish,
school, agency or institution in the Diocese of Springfield in Illinois cooperates fully with the authorities to investigate all
cases of alleged abuse. Abuse of minors or vulnerable adults is grounds for immediate dismissal and possible criminal
charges.

7. I understand that this is an application for employment and that no employment contract is being offered and
that if I am employed, such employment is for no definite period of time. I further understand that wages, benefits, job
responsibilities, work schedules and any other conditions may change at any time without my prior consent. I understand
that this application is good only for ninety, (90), days from today’s date. If I still desire a position after this application
expires, it will be my responsibility to fill out a new application. Otherwise I will not be considered for employment after
this application expires.

8. I understand I can withdraw from the application process at any time.

I have read and understood the above statement.

Signature _____________________________________________________ Date: ______/_______/_______

Page 1
 Applicants for Professional Employment – Teacher/Principal
Catholic Diocese of Springfield in Illinois

IMPORTANT: Please Take Extra Care To Make Your Entries Very Clear and Easy to Read.
Name(Please Print):

Last First MI

Maiden and/or Former Name(s) Social Security Number

MO Day YR
/ /
Drivers License # State Email (Home) Today’s Date

Current Address City State Zip Code County

How Long have you lived there? ____________ Why did you move?

Last Address City State Zip Code County

Home Phone: ( ) Work Phone: ( ) Cell Phone: ( )

Do you have access to transportation which will enable you to get to and from work? Yes No

Have you applied here before? Yes No If yes, what year? __________

Answer only if box is checked What religion do you practice?___________________________________________________

If you are not of the Catholic faith Are you an active member?
what is the name of your Church? _________________________________________________________ Yes No

Are you a member of a Catholic If yes list the name of the parish: _________________________________________________
parish?
How long have you been a member: __________________ months/years
Yes No
Please indicate if you are: An existing employee for this parish, or
Not currently an employee, but applying to become an employee.

Name of Religious Order (For religious sisters, brothers, priests): ______________________________________________________________

What position are you seeking: Teacher Principal

Date Available for Employment:____/_____ /_____ Salary Requirement $_____________ Per _____________Hr Wk Mo Yr

Page 2
Applicants for Professional Employment – Teacher/Principal

What interests you about the position:

What has prepared you for the position:

Were you previously employed by the Diocese in any Catholic parish or school or other Catholic Agency? Yes No
Are you seeking employment within a specific parish/geographical area? If yes, list below Yes No

If available, would you be open to other parish/geographical areas? Yes No

Have you been convicted or plead guilty to a misdemeanor or any offense that involves embezzlement, fraud, stealing, robbery,
violence or physical or sexual assault, abuse, neglect or misconduct in any form ? Yes No If yes, explain ____

____________________________________________________________________________________________________________

Have you been convicted or plead guilty to a felony within the last ten years Yes No If yes, explain

____________________________________________________________________________________________________________
*While a conviction record is considered, it is not automatic grounds for rejecting an application for employment. Circumstances surrounding the conviction are
considered.

Do you have any commitment to another employer that might affect your employment with the parish, school, agency or institution in
the Diocese of Springfield in Illinois? Yes No

Are you currently eligible to work in the United States? Yes No Are you under 18 years old? Yes No

Are you presently employed? Yes No In the last ten years, how many times have you been fired or asked to resign?

Over 10 times 6-10 times 4-5 times 2-3 times Once Never Describe all job situations in which you were fired or
asked to resign: (If more room is needed, please use the back of the application)
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Page 3
Education Name & Location Years Major Degree Grade Point Grade Point
Completed Course Average Scale
High School

College

College

Post Grad

Business or
Trade

List all employment in the last 10 years regardless of length of employment, starting with the most recent or current. Explain any
gaps in employment in the section provided. If more space is needed please provide a separate sheet of paper.
Employer Name City & State Immediate Supervisor Name
Started _____/_____/_____

Ended _____/_____/_____ Position Held Reason for Leaving

May we contact for reference Yes No Phone No. : ( )

Beginning Rate of Pay: $ Ending Rate of Pay: $
Employer Name City & State Immediate Supervisor Name
Started ____/_____/_____

Ended _____/_____/_____ Position Held Reason for Leaving

May we contact for reference Yes No Phone No. : ( )

Beginning Rate of Pay: $ Ending Rate of Pay: $
Employer Name City & State Immediate Supervisor Name
Started ____/_____/_____

Ended _____/_____/_____ Position Held Reason for Leaving

May we contact for reference Yes No Phone No. : ( )

Beginning Rate of Pay: $ Ending Rate of Pay: $
Employer Name City & State Immediate Supervisor Name
Started ____/_____/_____

Ended _____/_____/_____ Position Held Reason for Leaving

May we contact for reference Yes No Phone No. : ( )

Beginning Rate of Pay: $ Ending Rate of Pay: $

Certificate State Certificate No. Type Grade Level(s) Expiration Date

Teaching

Administrative

Other Teaching/Administrative State Type Date

Certificates

Student Teaching:
State Subject Area Dates

Page 4
Teachers - Preferences: List all positions which you are qualified to hold and wish to be considered for, in order of preference.
Grade Level Subject/Specialty Indicate full or
part-time

Additional Skills or Qualifications (professional administrative training, certification and experience, Catholic school experience—
attendance, teaching or administration, religious education training or experience)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Referral Source: Advertisements Employee Relative Government Employment Agency Walk-in
Private Employment Agency Other __________________________________________________________________

References: Professional/Academic - List three recent academic or professional references (include your
immediate supervisor)

Reference Name __________________________________________________________________________

Address: ________________________________________________________________________________

Daytime Phone: ____________________________ How long have you known this person? ____________
Has this person agreed to provide a reference? Yes No

Reference Name __________________________________________________________________________

Address: ________________________________________________________________________________

Daytime Phone: ____________________________ How long have you known this person? ____________
Has this person agreed to provide a reference? Yes No

Reference Name __________________________________________________________________________

Address: ________________________________________________________________________________

Daytime Phone: ____________________________ How long have you known this person? ____________
Has this person agreed to provide a reference? Yes No

Reference Name __________________________________________________________________________

Address: ________________________________________________________________________________

Daytime Phone: ____________________________ How long have you known this person? ____________
Has this person agreed to provide a reference? Yes No

Page 5
Expectations of both Catholics and Non-Catholics:
In this age of ambiguity, we want to be very clear about our Church affiliation requirements for teaching in a
Catholic school. To meet Church affiliation requirements we are asking you to complete this form as a part of
your application process. Please note, the requirements for employment include, but are not limited to, the
standards referred to in the questionnaire. If you are called for an interview, other areas will be explored. The
employer will also want to discuss the level of your knowledge of and commitment to your faith.

Standards necessary to teach in a Catholic school in the Catholic Diocese of Springfield in Illinois include but
are not limited to the following expectations:

 Conduct and lifestyle which is consistent with Catholic moral standards and avoiding those which are
inconsistent, keeping in mind all human beings are to be accepted with respect, compassion and dignity
in accordance with the catechism of the Catholic church. For example: remarriage without annulment,
co-habitation without valid marriage, and practicing or avowed homosexuality are not acceptable.

 Living a moral life either as a single person or being validly married and observing fully the obligations
of that state of life.

 Willingness to be part of the faith community of the school (i.e. attend liturgies and pray with students
and staff).

 Understanding Catholic moral standards and doctrine and supporting them when called to do so

 Understanding and accepting Catholic social justice teachings and supporting them when called to do so.

 Teaching or advocating Scriptural interpretations consistent with the teaching of the Catholic Church
and avoiding those which are inconsistent.

 Teaching or advocating a moral stance consistent with Catholic teachings and avoiding those which are
inconsistent: For example: teaching or advocating abortion, sterilization or contraceptive techniques is
not acceptable.

 Public dissent from any official teaching of the Catholic Church is not acceptable.

 Willingness to promote the Catholic faith development of the students.

ADDITIONAL EXPECTATIONS OF CATHOLICS:

 Conduct and lifestyle which are consistent with Catholic doctrine (as well as morality) and avoiding
those which are inconsistent.

 Regular attendance at Sunday liturgy and financial support of one's parish.

Are you willing to abide by these stipulations?_______

_______________________________________________ Date ______________________

Signature

Page 6