Personal Information 1 of 3 < Previous Next > We appreciate your interest in the Roman Catholic Diocese of Syracuse. The Roman Catholic Diocese of Syracuse offers equal opportunities to all persons without regard to race, color, religion, age, sex, disability, national origin, ancestry, citizenship, military or veteran status, marital status, sexual orientation, domestic violence victim status, predisposing genetic characteristics or genetic information, or any other status protected by law. Applicants who require reasonable accommodation during the application process may contact Human Resources at 315-422-9092. First Name: * Middle Initial: Last Name: * Telephone: * Street: * City: * State: * Zip: * Email: * Are you over 18 years of age? * Yes No If under 18 years of age, do you have a work permit? Yes No Are you legally eligible for employment in the United States? * Yes No In compliance with Federal Law, all persons hired will be required to verify identity and elgibility to work in the United States and to complete the required I-9 employment eligibility verification document upon hire. Have you ever been convicted of a criminal offense (felony or misdemeanor)? * Yes No If yes, please explain. Please include in your explanation the date and place of conviction, and the crime for which you were convicted. 1. Has a civil complaint ever been filed against you that alleged sexual misconduct or child abuse by you or your participation in or facilitation of such activities (including internal complaints given to management or supervisors at places of employment)? * Yes No If yes, explain. Please provide the date, nature, and place of the incident leading to the complaint; where the complaint was filed; disposition of the complaint; and identify by the name and title the person(s) who investigate the complaint. 2. Do you presently serve, or have you ever served, as a volunteer for any organization, entity or group in which you had contact with children or other vulnerable populations (e.g. elderly, mentally or emotionally handicapped, etc.)? * Yes No If yes, please provide the name, address, and phone number of the organization, period of volunteer service, supervisor’s name; and briefly describe your activities and/or duties. 3. Have you ever chosen not to renew or continue any employment or volunteer service, had your employment or volunteer service terminated, or been subject to any disciplinary action, for reasons relating to allegations of sexual misconduct or child abuse by you? * Yes No If yes, please explain. Please include in your explanation the date, nature, and place of the occurrence(s) or allegations and the disposition of the matter(s). Also, identify your employer and supervisor at the time by name, address and telephone number. Next > Position Details 2 of 3 < Previous Next > Position applied for: * Date you can start: Have you ever worked for the Diocese before? * Yes No When: * Supervisor: * Reason lor leaving: * Location: * The Syracuse Diocese requires employees to participate in their Child and Youth Protection Training by attending a VIRTUS training session. Have you ever received VIRTUS training? * Yes No Location: Date: Education Name and location of School Minor/Major and Degree Received Yr. of Graduation Name @ Graduation High School * College College Post Graduate Other Training References Please give the names of three persons not related to you, whom you have known professionally at least three years Reference One Name * Address * Telephone * Years known * Reference Two Name Address Telephone Years known Reference Three Name Address Telephone Years known Are you applying for a position in the Catholic Schools? * Yes No Please specify which school(s) - check all that apply. All Saints Catholic School of Endicott Bishop Grimes Jr./Sr. High School of East Syracuse Bishop Ludden Jr./Sr. High School of Syracuse Blessed Sacrament School of Syracuse Cathedral Academy at Pompei of Syracuse Holy Cross School of DeWitt Holy Family School of Syracuse Holy Family School-Norwich of Norwich Immaculate Conception School of Fayetteville Most Holy Rosary School of Syracuse Notre Dame Elementary of Utica Notre Dame Jr./Sr. High School of Utica Rome Catholic School of Rome Seton Catholic Central of Binghamton St. James School of Johnson City St. John the Evangelist School of Binghamton St. Mary's Academy of Baldwinsville St. Mary's School of Cortland St. Patrick's School of Oneida St. Rose of Lima School of North Syracuse Trinity Catholic School of Oswego Are you applying for a Teaching, Guidance or School Administration position? * Yes No Teachers/Substitute Applicants Religion: * Church of Attendance: I am interested in teaching the following: * Secondary (7-12) , subject area(s): Elementary Pre-K K-3 4-6 , preferred subject area(s): I am interested in teaching opportunities: * Full-time Part-time Substitute work Recent professional and civic activities (please provide descriptions of workshops, in-service, volunteer): I have experience as a full-time teacher: * Yes No if yes, for how many years? where? I have experience as a part-time teacher: * Yes No if yes, for how many years? where? Certifications: Do you have teaching certifications? * Yes No Certification 1 State Type Area Certification Number Date Issued Expiration Certification 2 State Type Area Certification Number Date Issued Expiration If you have other skills that will enhance you as a faculty member in a Catholic school (please list them): Why do you wish to teach in a Catholic School?: Guiding Principles for Teachers/Administrators in Catholic Schools: Education is one of the most important missions of the Church. All Catholic School educators continue to share in the mission of the Church "making faith become living, conscious and active through the light of instruction." (To Teach as Jesus Did) "The Catholic School is the most unique setting within which this ideal can be realized. Indeed, Catholic Schools are the most effective means available to the Church for the education of children and young people." (Sharing the Light of Faith) The success of our Catholic educational system depends upon professional competence and the quality of instruction. It also depends on the dedication and commitment of the educator. (initial) * I have read the guiding principals and I agree that, if employed by a Catholic School in the Diocese of Syracuse, I will teach and act in accordance therewith. (initial) * I understand the credentials files in support of this application become the property of the Catholic Schools Office and will not be returned to me. (initial) * I further realize that any material omission or falsification provided by me in this application will result in its invalidation. < Previous Next > Employment History 3 of 3 < Previous Next > Check if you have no employment history List all your work experience (starting with your most recent employer). Please account for all periods of unemployment in this section. Most Recent Employer Date Employed From: * Date Employed To: * Salary Start Salary Finish Name of Employer * Address * Phone * Job Title * Name of Supervisor * Briefly describe your job duties and work experience * Reason for leaving * May we contact your present employer at this time: * Yes No You may attach a cover letter here - not required - (max 500kb - Word or PDF fies ONLY) Your file is larger than 500kb, please select another. You may attach a resume here - not required - (max 500kb - Word or PDF fies ONLY) Your file is larger than 500kb, please select another. Add Additional Previous Employer Previous Employer Date Employed From: Date Employed To: Salary Start Salary Finish Name of Employer Address Phone * Job Title Name of Supervisor Briefly describe your job duties and work experience Reason for leaving Add Additional Previous Employer Previous Employer Date Employed From: Date Employed To: Salary Start Salary Finish Name of Employer Address Phone * Job Title Name of Supervisor Briefly describe your job duties and work experience Reason for leaving Applicant's Statement NOTE: Any correspondence, interview notes and the results of the criminal background check and reference checks will be filed with this application. The use of this application form by the Diocese or an individual entity in no way indicates that employment is offered or necessarily will be offered by the Diocese of Syracuse. Eligible applicants may be offered employment by the local entity, which is the employer of record. IMPORTANT: by my signature below, I certify that the information provided in this application is true, correct and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I grant permission to check my background and references and release the Diocese of Syracuse and the Diocesan locations from any and all resultant liability. If welcomed as an employee, I will abide by the "Child and Youth Protection Policy" and the other policies and procedures of the Diocese of Syracuse. I understand that the acceptance of an offer does not create any obligation upon the Diocese to permit my continuing service. I further understand that while not all positions are security sensitive, I acknowledge that all employees are required to undergo a criminal background check and "Child and Youth Protection Training". I will be required to furnish proof of identity in association with the criminal background check. (initial) * I have read above statements. Signature: * (Please enter your full name here) < Previous