RETURN TO:
QDA - CEO
400 Mill Ave SE, Suite 901
New Philadelphia, OH 44663
Quaker Digital Academy
Telephone: 330-364-0618 | Fax: 330-364-0680 | go2qda.org
Professional Employment Application
Last Name First Name Middle or Maiden Name
Street Address City State ZIP
Primary Phone Number Secondary Phone Number
To assist in maintaining contact with me, here is the name, address and phone number of a person through whom I may be reached.
Name of Contact Person Phone Number
Street Address City State ZIP
NOTE: Please submit a photocopy of all of your Ohio teaching certificates with this application. If certificate is pending, please indicate expected
date of issuance.
Name of Ohio Teaching
Cert./Lic. You Hold
Date
Issued
Date of
Expiration
Certificate/License
Number
Subjects or Grades
Appearing on Cert./Lic.
Regular Teacher Substitute Teacher Tutor
Interested in (check all that apply):
K-12 Pre K K-3 4-5 6-8 9-12
Grade Level:
Subject/Area of Position Desired
Teaching Preferences - Please indicate your 1st choice of subject and grade level you prefer.
Teaching Preferences - Please indicate your 2nd choice of subject and grade level you prefer.
Teaching Preferences - Please indicate your 3rd choice of subject and grade level you prefer.
"AN EQUAL OPPORTUNITY EMPLOYER"
Please complete this application on your computer system
Today's Date
PERSONAL DATA
CERTIFICATION/
LICENSE
TEACHING PREFERENCE
AND COMPETENCIES
