JOB APPLICATION FORM

Date:

Applying for (position):

PERSONAL INFORMATION Current Address:

Name:
Cell Number:
Skype Name:
E-mail:
Permanent Address:
Yes No

Gender : Have you ever been charged with any civil or criminal
Height : proceeding?
Weight : Yes No

If yes, did any involve improprieties with children?

Date of Birth: Yes No

Country:
If you answered “Yes” to any of the three questions above,
Passport Number:
please explain the details with dates and indicate the nature
Nationality: _________________________ of the
Country, if Dual Citizenship: Offense on an attachment to this application. :

Marital Status: Single Married Separated

Divorced

Spouse’s Name:

Country:
Passport Number:
Spouse’s Occupation and/or Past Employment:

Children: (Check those children who will accompany you to

Indonesia)

Name:
Birth date:

Name:
Birth date:

Name:
Birth date:

What length of time do you anticipate working for IPEKA?

Short term of 2 years 3 years or more

Have you ever been dismissed, resigned to avoid being

dismissed,
or asked to resign from a position?
 HEALTH
INFORMATION
Do you have or have you had any health condition(s) that has caused your work or education to be interrupted for an extended
period of time? Yes No
Have you smoked/do you smoke or use any tobacco products? Yes No
Have you used recreational drugs? Yes No
Do you have any tattoos? Yes No
Are you currently on any prescription medicine or under a doctor’s care? Yes No

If you have responded “Yes” for any of these health questions, please attach a page of explanation.
Teachers will be required to have a doctor’s physical check up and complete a full health history upon employment decision.
Philosophy of Christian School Education. INFORMATION

PHILOSOPHY OF CHRISTIAN SCHOOL EDUCATION

On a separate piece of paper write a one-page statement of your philosophy of Christian education and how you would biblically
integrate your subject areas.

EDUCATION INFORMATION

Educational Experience (Chronologically, beginning with the most recent Attendance/Degree)

University or College Attended Major(s) Minor(s) Degree(s) DateCompleted

Area as Certified to Teach

State/Province Certified & Certification
Period or Expiration of Teaching Certificate
Do you hold an ACSI Teachers Certification?
Level of certification
Period or Expiration of ACSI Teacher’s Certification

PROFESSIONAL EXPERIENCE INFORMATION

Teaching Experience (Chronologically, beginning with the most recent position)
School Dates Address Subject(s)

What plans do you have for future study?

Describe any short term or long-term overseas studies or travel.

If you have worked abroad describe how you adjusted to living in a different country
List any academic and athletic honors, extra-curricular activities and offices held.

Check experience and/or skills you have had outside the classroom.

Coaching Sport Praise Team Drama Christian Camping Entrepreneurship

Choir Biblical Studies Art – Medium _________
Instrumental Academic Teams Computers
Journalism ESL Web Design

What are your hobbies, skills and other interests?

Social Media Please do not set your social media platforms in private mode during recruitment process with IPEKA.

LinkedIn :
Instagram :
Facebook :
Other :

Current Salary:
Expected monthly Salary:

SPIRITUAL INFORMATION

Denominational Preference:
Name of church you attend:
Pastor’s or Deacon’s Name: Phone Number:
Church Address:
How many years have you been a born again Christian?
In what church activities do you regularly participate?

Describe your spiritual growth in the last 3 years:

Give a concise but adequate statement of your personal faith in Jesus Christ.
What is your attitude towards non-Christian religions?

What is your concern about LGBTQ movement throughout the world nowadays?

Are you strongly convicted that the Lord is leading you to teach at IPEKA and help support the mission of the school? Describe
briefly how you are beingled and convinced to serve at IPEKA

IPEKA Staff Guidelines

Staff is expected to be exemplary role models for students and the community at large both in and out of school. They are expected to
show moderation in all things and use wisdom and discretion in their conduct. They are expected to be above reproach at all times in
areas of sexual orientation and behavior, marital and parental relationships, personal finances, addictive substances, and leisure
activities. Violations of this code of behavior would be dealt with in accordance with biblical principles (Matthew 18:15-19). If
allegations are proven, this will be ground for dismissal. The school campus will be kept free of addictive substances (including
cigarettes & alcohol) for both staff and students. Any activities held on the premises must be edifying and glorifying to God.

Are you prepared to abide by these guidelines and to cooperate with your colleagues and the administrations under the authority of
the IPEKA CHRISTIAN SCHOOL Board? Yes No

IPEKA STATEMENT OF FAITH

We believe in:

Bible
The Bible as originally given is inerrant, inspired by God, and the only authority for faith, truth and practice

God
God is Trinity-One Being, Father, Son, and Holy Spirit.

Jesus is fully God and fully man. His life was sinless. He died as a sacrifice for our sins. He rose the third day. He ascended into
heaven and will return to earth some day.

The Holy Spirit lives and works in the life of every believer. He guides through inner conviction and helps the believer understand
the Bible.

The Holy Spirit grants gifts to believers-including prophecy, teaching, exultation, evangelism, leading, and serving.

People
Every person is a sinner by nature and practice.

Salvation
A person becomes saved by repenting of their sins and inviting Jesus Christ into their life. Their sins are forgiven and they become
children of God.
 I certify the above doctrinal statement of faith to be a correct statement of my personal beliefs. I declare the information supplied on
this application is accurate and complete to the best of myknowledge and I understand if I willfully give any false information, I shall
render myself liable to dismissal, despite any appointment of service at IPEKA. I understand IPEKA reserves the right to verify the
accuracy of the above data.

Signature Date (m/d/y)

Typing in your name is acceptable as a signature

REFERENCE
The applicant is responsible to provide the following reference from three organizations/people. Please include a spiritual mentor,
your current supervising administrator and one professional teaching reference.

ATTACHMENT CHECKLIST
● Passport Style and Size Photo 1 ¼’, 1 ¾’ ● Resume/CV

● University Transcripts ● Copy of all pages of your Passport

● Copies of all university diplomas ● Marriage License (If Applicable)

● Philosophy of Christian School Attachment- 1 page ● Criminal Proceeding Explanation (If applicable)

● Copies of Professional Certification ● Health Explanation (If applicable)

PERSONAL REFERENCE FORM

(Applicant Name) has completed a teaching application to teach at IPEKA CHRISTIAN SCHOOL in Jakarta, Indonesia. Our school
has 1,200 students in grades Kindergarten through 12 th grade and is distinctively Christian institution for college prep students. Our
student body is made up primarily of Chinese Indonesian children.

Thank you for taking the time to briefly comment on the teaching ability, experience, personality, leadership qualities, academic
interests and adaptability of the applicant. Please use the space below and feel free to add an additional page (if you prefer to send a
letter instead of this form, we would be happy to accept it).

Name Company/Position

Email Address Phone

Signature Date
APPLICANT’S AGREEMENT

I understand that IPEKA Christian School does not discriminate in its employment practices against any person because of race,
color, national or ethnic origin, gender, or disability.

I hereby certify that the facts set forth in this initial application are true and complete to the best of my knowledge.

I authorize IPEKA International Christian School to investigate references, work records, evaluations, education, and other matters
related to my suitability for employment.

I authorized references and former employers to disclose to the school any and all employment records, performance reviews, letters,
reports, and other information related to my life and employment, without giving me prior notice of such disclosure.

Since I will be working with children, I understand that I may be required to submit to a fingerprint check by the FBI and/or a police
background check.

I understand that this is only an application for employment and that no employment contract is being offered at this time.

I certify that I have carefully read and understand the above statements.

Applicant’s Signature Date