Arch Ford Education Service Cooperative
Contract Presenter Application
This institution is an equal opportunity provider.
Date
MM
/
DD
/
YYYY
Name
Address
Primary Phone
What type of line is the above number? (check one)
mobile
landline
Alternate Phone
What type of line is the above number? (check one)
mobile
landline
Do you consent to send and receive text messages? (check one)
Yes
No
Email Address
Are you currently employed? (check one)
Yes
No
If yes, who is your current employer?
Days Available to Work (mark all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Hours Available to Work (mark all that apply)
Morning (7 am - 12 pm)
Afternoon (12 pm - 5 pm)
Evening (5 pm - 10 pm)
Are you willing and able to travel?
Yes
No
If so, where are you willing to travel? (mark all that apply)
Central Arkansas
Northeast Arkansas
Northwest Arkansas
Southeast Arkansas
Southwest Arkansas
Is there anything that would prevent you from performing, in a reasonable and safe manner, any of the activities involved in the position of contract consultant?
Yes
No
If yes, please explain. You may decline to answer this question.
Are you fluent and literate in any other languages besides English?
Yes
No
If yes, please identify additional languages:
Education, Experience, Certifications and Credentials, Employment History, and Special Skills (Please attach a current resume and other related documents you may have.)
Resume
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Academic Transcripts
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Certification or Credential Verification
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Presentation Topic and Outline
Please describe your presentation topic.
Attach an outline of your presentation here.
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Fingerprinting and Criminal Background Check
Have you been fingerprinted for public school employment?
Yes
No
Have you had a criminal background check for public school employment?
Yes
No
If yes to the above two questions, do you give permission to Arch Ford to access these results if required?
Yes
No
Not Applicable
The information provided is true and correct to the best of my knowledge. By submitting my application for contract work, I agree to abide by policies and procedures established by Arch Ford Education Service Cooperative.
Yes
No
Verification
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