PreK-12 Teaching Artist Application PreK-12 Teaching Artist Application Instructor InformationName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Artist website/online portfolioOptional Short biography (1-2 sentences)*Resume*Please upload a current resume detailing your education and teaching experience.Accepted file types: jpg, pdf, doc, docx, xls, xlsx, rtf, txt, Max. file size: 5 MB.Artist statementOptionalAccepted file types: jpg, pdf, doc, docx, xls, xlsx, rtf, txt, Max. file size: 5 MB.Do you have prior experience teaching PreK-12 students in a museum/art center/school?*YesNoIf yes, briefly describe your experience working with PreK-12 studentsDo you have prior experience using original artworks as inspiration for class projects?*YesNoWhich program(s) are you interested in teaching? Literacy Through Art Summer Art Camp Winter Art Camp Makerspace Are you legally authorized to work in the United States?*YesNoComments – instructor information (optional)AvailabilityPlease indicate when you are available to teach at the Museum (choose all that apply).Day(s) of the week Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time(s) of day Morning Afternoon Evening Time(s) of year Spring (February, March, April) Summer (June, July, August) Fall (September, October, November, December) Comments – availability (optional)ReferencesPlease list two professional references who can speak to your experience in teaching studio classes to adults.Reference 1 – Name* First Last Reference 1 – Relationship to you (colleague, student, etc.)*Reference 1 – Email* Reference 2 – Name* First Last Reference 2 – Relationship to you (colleague, student, etc.)*Reference 2 – Email* Notice to Applicant/Employee Regarding Background InvestigationConsent*In connection with your application for employment or continuing employment, notice is hereby given that a consumer report and/or investigative report may be obtained from a consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or “investigative consumer report” as defined by the Fair Credit Reporting Act (15 U.S.C. § 1681 et seq.). These reports may contain information about your character, general reputation, personal characteristics, or mode of living, whichever are applicable. They may involve personal interviews with sources such as your neighbors, friends or associates. The reports may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records, education or employment history, or other background checks. By signing below, you acknowledge receipt of the Notice to Applicant/Employee Regarding Background Investigation and certify that you have read this disclosure. Furthermore, you authorize the obtaining of consumer reports and/or investigative consumer reports at any time after receipt of this authorization and throughout the course of employment, if applicable. The scope of the Notice to Applicant/Employee Regarding Background Investigation and your authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow us to conduct future screenings for retention, promotion, or reassignment, as permitted by law and unless revoked by you in writing. I understand and agree that: • A background check is a condition of my contract employment. • As a contractor, I am not entitled to worker’s compensation or group benefits in the event of injury. • The Asheville Art Museum reserves the right to an evaluation sometime after placement and the right to terminate services should responsibilities not be fulfilled satisfactorily. I understand and agree.Legal name (Last, First, Middle, Maiden)*Required for a background checkSocial Security Number*Required for a background checkDate of birth*Required for a background check MM slash DD slash YYYY Δ