NORTH CENTRAL CHARTER
essential school

1 Oak Hill Road
Fitchburg, Massachusetts 01420
Phone: 978.345.2701
FAX: 978.345.9127
[email protected]

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Please complete the following application form. All required items are indicated by . All other information is optional. Once you have completed the form, click on the "Submit Application Form" button.

If you are having difficulties submitting this form, please contact Technical Support and inform them of your problem or use our PDF form. Thank you for your cooperation.

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Thank you for applying with North Central Charter Essential School. We will be in touch with you shortly regarding your application. You may click on the button to print out this application form for your records.

Contact Information		Date:
	Name:
		First	Last
	Address:
		Present, please include City, State & Postal Code
	Address:
		Permanent, please include City, State & Postal Code
	Home Phone:
			Best time to call you
	Work Phone:
			Best time to call you
	E-Mail:
	Position applying for:
	Hear about?:

Education
	School Name:
		Most Recent
	School Address:
	Dates Attended	Diploma or Degree	Date Awarded (MM/YY)
	School Name:
		Previous Attended
	School Address:
	Dates Attended	Diploma or Degree	Date Awarded (MM/YY)
	School Name:
		Previous Attended
	School Address:
	Dates Attended	Diploma or Degree	Date Awarded (MM/YY)
	School Name:
		Previous Attended
	School Address:
	Dates Attended	Diploma or Degree	Date Awarded (MM/YY)

Professional Certification and/Licenses Held
	Type of Certificate/License:
				Issuing State or Organization
	Type of Certificate/License:
				Issuing State or Organization
	Type of Certificate/License:
				Issuing State or Organization
	Type of Certificate/License:
				Issuing State or Organization

Teaching Experience  Please do not write "see resume." The information provided below will be used to determine placement on the North Central Charter salary schedule.
	School System:
		Most Recent
	Grades or Subjects Taught:
		Dates	Annual Salary
	School System:
		Previous
	Grades or Subjects Taught:
		Dates	Annual Salary
	School System:
		Previous
	Grades or Subjects Taught:
		Dates	Annual Salary
	School System:
		Previous
	Grades or Subjects Taught:
		Dates	Annual Salary
	School System:
		Previous
	Grades or Subjects Taught:
		Dates	Annual Salary
	School System:
		Previous
	Grades or Subjects Taught:
		Dates	Annual Salary

References  Minimum of three (3) - non-relatives only please. Immediate supervisor or principal, a college and a student.
	Name:
		Full Name
	Address:
		Full address, please include City, State & Postal Code
	Occupation:
	Home Phone:		Either a home or  work phone number,   or email address is acceptable as long   as we can get in contact with your reference.
	Work Phone:
	E-Mail:
	Name:
		Full Name
	Address:
		Full address, please include City, State & Postal Code
	Occupation:
	Home Phone:		Either a home or  work phone number,   or email address is acceptable as long   as we can get in contact with your reference.
	Work Phone:
	E-Mail:
	Name:
		Full Name
	Address:
		Full address, please include City, State & Postal Code
	Occupation:
	Home Phone:		Either a home or  work phone number,   or email address is acceptable as long   as we can get in contact with your reference.
	Work Phone:
	E-Mail:

Awards and Achievements  List & describe any awards and/or notable achievements you have received or attained.

Other Information
	Foreign Languages Spoken:
	Special Interests/Travel:	Use the box below to indicate any special interests, travel    restrictions, or other general information you consider    important to your application.

Attachments  Please attach your resume, cover letter & reference letter using the entries provided. If you have an additional document that you feel would be beneficial to your application, please attach it using the "other" field.
	Resume:
	Cover Letter:	Please address the following questions (no more than 3 pages please):
		What do you see as the special rewards and challenges of working with kids in grades 7-9? Life-long learning - What might show us that you’re coming here ready to learn. Diversity - What do you see as the special rewards and challenges of working with a diverse mix of students? What is your interest in or knowledge of essential schools? In what ways have you contributed to your school community beyond regular classroom work? What are your passions, interests, or hobbies that you might want to share with students?
		** We’re aware that your writing will be on display here. Literacy and written communication  will be a school-wide focus. Please share with us any special circumstances that affect your ability to write.
	Reference Letter:
		A copy of a reference letter that you have written for a student or an equivalent document.
	Other:
		YOU CAN NOT EXCEED 1M BYTE FOR EACH FILE
We use MS Office XP on iNtel platforms so we are compatible with most word processing applications. If you are using incompatible applications, please use plain text files for your attachments. Thank you for your cooperation.

Title IX Compliance

This school will not discriminate in educational programs, activities, or employment Practices on the basis of race, language, sex, age, color, national origin, religion, marital status, pregnancy, sexual orientation, or disability under provisions of Title IX of the Educational Amendments: Section 504 or the Rehabilitation Act of 1973.

 

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