Wufoo

Great Southern Virginia Teacher Recruitment Fair

March 8, 2008
Attendee Registration Form

ATTENDEE INFORMATION (This is not an application for employment)
Name Title First Last Suffix
Date of Birth / MM / DD YYYY
Last Four of SSN
Phone(s) - (###) - ### ####
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
EMPLOYMENT INFORMATION (TEACHING POSITIONS HELD SHOULD BE LISTED FIRST, EVEN IF NOT YOUR CURRENT POSITION)
Current Employer
Job Title
Years Experience
Job Responsibilites
City and State
Previous Employer (Most Recent)
Job Title
Years Experience
Job Responsibilities
City and State
EXPERIENCE AND EDUCATION
Virginia Teaching Certificate? Yes No
Endorsement Areas:
Do you have student teaching experience Yes No
Name of College/University (most recent)
Program of Study
City and State
Degree/Certificate Earned
Year Degree/Certificate Awarded
ADDITIONAL INFORMATION
Current Visa Status
Felony/Convicted of a Crime or Misdemeanor? Yes No
How long ago?
City and State
AUTHORIZATION

I certify that the above information relating to my interest/involvement in the Great Southern Virginia Teacher Recruitment Fair is true and accurate to the best of my knowledge. I am aware that this is not an employment application. I am aware that such information is subject to review and verification, and that I may have to provide documents to support the information provided. I hereby authorize the release of this information and the results of any pre-employment assessments to be provided to prospective employers. I am willing that a photocopy of this "Attendee Registration Form" be accepted with the same authority as the original, and I specifically waive any written notice from any present and former employers who may provide information based on this authorized request. I understand that my name and birthday ( in lieu of SS#) will be added to a data base to be provided to a number of employers participating in this and future job fairs.
Name of Applicant

NOTICE: THIS SERVES AS YOUR SIGNATURE ON THIS ONLINE FORM
Date Signed / MM / DD YYYY
Do Not Fill This Out

Wufoo

Great Southern Virginia Teacher Recruitment Fair

ATTENDEE INFORMATION (This is not an application for employment)

EMPLOYMENT INFORMATION (TEACHING POSITIONS HELD SHOULD BE LISTED FIRST, EVEN IF NOT YOUR CURRENT POSITION)

EXPERIENCE AND EDUCATION

ADDITIONAL INFORMATION

AUTHORIZATION