First Name*
Last Name*
Email Address*
Phone*
Are you, or will you be, actively drawing a pension from the Arizona State Retirement System (ASRS) when you begin working for ESI?*
-- No answer -- Yes No
When was/is your ASRS retirement date (mm/dd/yyyy)?*
Do you hold an Arizona IVP Fingerprint Clearance Card?*
-- No answer -- Yes No
Do you hold an Arizona Teaching / Administrative / Substitute Certificate?*
-- No answer -- Yes No
Enter the full name of the district that is recommending you for hire with ESI (e.g. Scottsdale Unified School District)*
Enter your school, department, or work site location.*
Enter the position title.*
Enter your expected start date with ESI (mm/dd/yyyy).*
Have you ever had a teaching certificate or professional license revoked or suspended?*
-- No answer -- Yes No
If Yes to the above, you must provide a thorough explanation. Otherwise, enter "N/A" below.*
Are you currently or have you ever been subject to an investigation by any department of education or police department, and/or been placed on administrative leave?*
-- No answer -- Yes No
If Yes to the above, you must provide a thorough explanation. Otherwise, enter "N/A" below.*
Have you ever failed to be rehired, been asked to resign from a position, resigned to avoid termination, or been terminated from employment?*
-- No answer -- Yes No
If Yes to the above, you must provide a thorough explanation. Otherwise, enter "N/A" below.*
Have you ever been arrested and/or fingerprinted for any offense regardless of its outcome in court?*
-- No answer -- Yes No
If Yes to the above, you must provide a thorough explanation. Otherwise, enter "N/A" below.*
Are you able to perform the essential job functions with or without a reasonable accommodation?*
-- No answer -- Yes No
Are you eligible to work in the United States?*
-- No answer -- Yes, I am a U.S. Citizen/Permanent Resident Yes, I am a non-citizen allowed to work for any employer No, I am not eligible to work in the United States
Have you ever been convicted of, admitted committing, or are awaiting trial on Child Abuse charges? (Please note: Applicants are not obligated to disclose sealed or expunged records.)*
-- No answer -- Yes, I have been convicted of, admitted committing, or am awaiting trial on Child Abuse charges. No, I have not been convicted of, admitted committing, or am not awaiting trial on Child Abuse charges.
Does your name appear on any Sex Offender Database in any state or country?*
-- No answer -- Yes, my name appears on a Sex Offender Database. No, my name does not appear on a Sex Offender Database.
By acknowledging "I Agree" you declare that the information you provided on this application is true and correct, and understand that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. You acknowledge that once you submit this application, you cannot view or alter your responses.*
