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Summary
Title:	Teacher Assistant
ID:	002LSTA
Program or Departments:	Lakeview School
Job Locations (NJ):	Edison
Job Category:	F/T
Job Type:	Day
Salary:	$21.50 per hour - Teacher Assistant
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
Cell Phone:
* Email:
Application Information
* Source:
If referral, Employee Name:
Opt-In Confirmation
	By submitting this application, I consent to receive SMS updates from NJID at 8556268627 regarding my employment application. My information will not be shared or used for any other purposes. This application is powered by ApplicantStack on behalf of NJID. SMS messages will only be sent by NJID and are used exclusively for hiring-related communications when you have subscribed to receive SMS communications.
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Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Teacher Assistant

* Do you have a NJ DOE Substitute Certification?

Yes No

* Do you have experience working with children in a school setting?

Yes No

EMPLOYMENT APPLICATION FOR LAKEVIEW SCHOOL

New Jersey Institute for Disabilities

The New Jersey Institute for Disabilities (NJID) is dedicated to the provision of comprehensive, superior, multifaceted programs of service to individuals with developmental and related disabilities regardless of race, gender, creed, economic status or age. To this end NJID shall:

offer programs to enrich the lives and enhance the development of each infant, child and adult with developmental and related disabilities to enable each individual to achieve full potential;
provide, as early as possible, evaluation, identification, diagnosis and treatment to infants, children and adults so that the number and severity of handicaps can be significantly reduced;
foster dignity, independence and purposefulness to all who enter into the NJID programs;
maintain the community's trust and confidence in the work of NJID.

PERSONAL INFORMATION

Best time to contact you is:

AM PM

* If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes No

* Have you ever been employed with us before?

Yes No

If Yes, give date

* Do any of your friends or relatives, other than spouse, work here?

Yes No

* Are you prevented from lawfully becoming employed in this country because of visa or immigration status? (Proof of citizenship or immigration status will be required upon employment)

Yes No

Are you currently employed?

Yes No

If so may we inquire of your present employer?

Yes No

When would you be available to begin work?

What is your desired salary range

Are you available to work:

Full Time Part Time Per Diem

Indicate availability

Why are you interested in this position?

What are your career goals?

EDUCATION

High School

Name

Location

Did you Graduate?

Yes No

Degree Received

Subjects Studied/Major

Undergraduate College

Name

Location

Did you Graduate?

Yes No

Degree Received

Subjects Studied/Major

Graduate Professional

Name

Location

Did you Graduate?

Yes No

Degree Received

Subjects Studied/Major

Have you received a high school equivalency certificate?

Yes No

If yes, Name of State:

Note to Applicants: DO NOT ANSWER THIS QUESTI0N UNLESS YOU HAVE READ THE JOB DESCRIPTION REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?

Yes No

State any additional information you feel may be helpful to us in considering your application.

Have you ever been the subject of any child abuse or sexual misconduct investigation by any employer, State licensing agency, law enforcement agency, or the Department of Children & Families where the findings were found to be five and/or substantiated?

Yes No

Have you ever been disciplined, discharged, non-renewed, asked to resign from employment, resigned from or otherwise separated from any employment while allegations of child abuse or sexual misconduct were pending or under investigation, or due to an adjudication or finding of child abuse or sexual misconduct?

Yes No

Have you ever had a license, professional license, or certificate suspended, surrendered, or revoked while allegations of child abuse or sexual misconduct were pending or under investigation, or due to an adjudication or finding of child abuse or sexual misconduct?

Yes No

Penalties Under Chapter 6 of Title 18 A

An applicant who willfully provides false information or willfully fails to disclose information required, shall be subject to discipline up to and including termination or denial of employment. The applicant or employee may be deemed in violation of subsection a. ofNJ.S.2C 28-3 and may be subject to a civil penalty of not more than $500 which shall be collected in proceedings in accordance with the Penalty Enforcement Law of 1999 PL 1999 C 274 (C2A-58-10 et seq.)

A school district, charter school, nonpublic school, or contracted service provider holding a contract with a school district, charter school, or nonpublic school shall include a notification of the penalties set forth in this section on all applications for employment for positions which involve regular contact with students.

* Signature (type name)

* Date

EMPLOYMENT EXPERIENCE

In accordance with Chapter 6 of Title 18A all candidates applying for a position with the Lakeview School must provide a list; including name, address, telephone number and other relevant contact information of the applicant's current employer AND all former employers within the last 20 years that were schools AND any employment within the last 20 years where the applicant was employed in a position that involved direct contact with children. Please provide this information below. Continue on an additional sheet of paper if necessary.

Employer 1

Job Title

From

Company Name

Company Address

Company Phone

Supervisor Name

Supervisor Title

May we Contact?

Yes No

Responsibilities

Reason for Leaving

Employer 2

Job Title

From

Company Name

Company Address

Company Phone

Supervisor Name

Supervisor Title

May we Contact?

Yes No

Responsibilities

Reason for Leaving

Employer 3

Job Title

From

Company Name

Company Address

Company Phone

Supervisor Name

Supervisor Title

May we Contact?

Yes No

Responsibilities

Reason for Leaving

Employer 4

Job Title

From

Company Name

Company Address

Company Phone

Supervisor Name

Supervisor Title

May we Contact?

Yes No

Responsibilities

Reason for Leaving

Employer 5

Job Title

From

Company Name

Company Address

Company Phone

Supervisor Name

Supervisor Title

May we Contact?

Yes No

Responsibilities

Reason for Leaving

CRIMINAL BACKGROUND CHECK DISCLOSURE AND CONSENT

IMPORTANT- PLEASE READ AND SIGN THE FOLLOWING:

I am applying for employment with the New Jersey Institute for Disabilities (NJID). By my signature below, I acknowledge that if offered employment I give my consent to NJID to obtain criminal history record information from the Federal Bureau of Investigation, Identification Division, and the New Jersey Division of State Police. I further consent to and will cooperate in supplying sufficient information to allow such a criminal history record background check to be obtained including supplying a fingerprint sample. I understand that this information will be used to evaluate me for possible employment. I understand that if I refuse to consent to this background check, my application for employment shall not be considered.

I shall be informed of the results of this criminal history record check. I shall also be granted the opportunity to correct any errors in the criminal history record.

* Signature (type name)

* Date

APPLICANT'S STATEMENT

ALL APPLICANTS PLEASE READ CAREFULLY

I understand that I have not yet been offered employment with the New Jersey Institute for Disabilities. Should I be offered such employment, I understand that such employment is at will, meaning that I may be discharged with or without notice and with or without cause at the complete discretion of the New Jersey Institute for Disabilities. Further, no employee, manager or agent of the New Jersey Institute for Disabilities other than its chief executive officer (or other designated individual) has the authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing. I further understand that any amendment to the foregoing must be in and signed by the New Jersey Institute for Disabilities' chief executive officer (or other designated individual).

I certify that the information which I have provided on this "Application for Employment" is true and complete to the best of my knowledge. I understand that any omission of information or misrepresentation by me on this application, including failure to reveal any prior employment, will be cause for rejection of my application or immediate at any time after employment.

I hereby authorize disclosure to the New Jersey Institute for Disabilities of all information requested in furtherance of my job application as well as all information requested under Chapter 6 of Title 18A Subsection B, and the disclosure and release of all related records. I release all employers and entities from any liability that may arise from the disclosure or release of all records and information as required by this Act.

* Signature (type name)

* Date

According to the Policies and Procedures of the New Jersey Institute for Disabilities, a signed declaration, indicating whether or not each applicant has been convicted of a crime, must be obtained. If offered employment, your statement below will serve as a sworn declaration of your criminal history until you have been fingerprinted, and your background check is completed as required by the New Jersey Department of Disabilities (NJ.S.A. 30:6D-63 to 72) and or the New Jersey State Department of Education (NJ.S.A. 18A:607.1 or 18A:64.13).

***Please note that a criminal conviction will not automatically disqualify an applicant from employment with NJID.

* Have you ever been convicted of a crime??

Yes No

* Have you ever been found civilly or criminally liable for abuse of an individual with a developmental disability

Yes No

If yes to either question, please explain the circumstances in full detail:

* Signature (type name)

* Date

Equal Opportunity Employment

We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.

Gender:

Female
Male
I Choose Not to Respond

Race/Ethnicity:

	American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
	Black or African American (Not Hispanic or Latino) A person having origins in any of the Black racial groups of Africa
	Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
	Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
	White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
	Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
	Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above races
	I Choose Not to Respond

Veteran Status: (Please check all that apply)

	Individual with a Disability An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
	Vietnam Era Veteran A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred - a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5,1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
	Disabled Veteran 1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability
	War/Campaign/Expedition Veteran A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized
	Armed Forces Service Medal Veteran A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty
	Recently Separated Veteran Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

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