New Employee Information Form

Please complete the form below. Required fields marked with an asterisk *

Completing this form does not constitute a promise or guarantee of employment.

For details and information regarding your employment please contact the school office.

VCPS is an Equal Opportunity Employer.

School Site*

Answer Required

VCLA - Vista Charter Middle School - Los Angeles

HRZN - Vista Horizon Global Academy - Los Angeles

HRTG - Vista Heritage Global Academy - Santa Ana

CNDR - Vista Condor Global Academy - Santa Ana-

MRDN - Vista Meridian Global Academy- Santa Ana

VCPS - Vista Charter Public Schools District Office

PLMN- Palm Lane Global Academy

Grades/Subjects (Example: 7th grade-Mathematics)

For teachers only

Answer Required

Start Date: (please ask your office manager)*

Answer Required

First Name*

Answer Required

Middle Initial

Answer Required

Last Name*

Answer Required

Date of Birth*

Answer Required

Gender*

Answer Required

Male

Female

SSN (Not Required-Leave Blank)

Answer Required

California Driving Licence Number:*

Answer Required

CDL Exp. Date*

Answer Required

Personal Email*

Answer Required

Mobile Phone*

Answer Required

Home Phone

Answer Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Hispanic or Latino Ethnicity*

(Hispanic is person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)

Answer Required

Yes

Emergency Contact Information

First and Last Name of Emergency Contact Person

Answer Required

Relationship to emergency contact

Answer Required

Emergency Contact's Mobile Phone

Answer Required

Emergency Contact's Other Phone(optional)

Answer Required

TB Skin Test Date

(Please provide copy)

Answer Required

Previous Retirement Plan:

Answer Required

STRS

PERS

PARS

Other:

STRS BUY BACK:

Answer Required

Total years in teaching or administrative service. Other jobs put 0 *

If this is not your first teaching or administrative job, how many years have you been in service as teacher or/and administrator?

Answer Required

Please list Previous Employer(s) Name and Contact Information, Length of Service, Position/Title, and Reason for Leaving

Answer Required

List all teacher credential documents:

(Please provide copy)

Answer Required

Please fix the highlighted areas below before submitting.

New Employee Information Form