|
Date___________________
PERSONAL:
Name_________________________________
SS#_______________________
Present
Address_____________________________________________________
Permanent
Address___________________________________________________
Home
Phone#___________________ Work Phone#________________________
Have
you ever been convicted of a felony? _____If so,
what?___________________
EMPLOYMENT
DESIRED:_____________________________________________
K-6_____________ 7-8______________ 9-12_____________
DEGREE(S):Bachelors___________
Masters___________ Other_______________
Major(s)
________________________ Minor(s) ___________________________
#Semester
hours__________________ #Semester Hours_____________________
IL
Cert.#__________ Type___________ Cert. Registered
in____________County
If
you do not possess an Illinois certificate, have you made
application?____________
Extra-curricular
activities you can direct?___________________________________
STUDENT
TEACHING
Dates:
City
and State_____________ Grade/Subject____________ From_____ To______
Grade
Received_______________________________________
Supervising
Teacher____________________________________
Home
Phone#______________________ School
Phone#___________________________
|
EDUCATION: |
Name
of School |
#
Years Attended |
Graduated
Yes \ No |
Major
Field |
|
High
School |
|
|
|
|
|
College
or University |
|
|
|
|
|
College
or University |
|
|
|
|
AVAILABILITY
Date
you can start_______________ Are you employed
now?__________________
If
so, may we inquire of your present
employer?______________________________
May
we contact other references prior to an
interview?_________________________
FORMER
EMPLOYERS: Please list below your last four employers
(most recent one first).
(Please
give teaching experience only)
|
Month/Year |
Name/Address
of Employer |
Home
Phone |
Work
Phone |
Position
Held |
Reason
for Leaving |
|
From
To |
|
|
|
|
|
|
From
To |
|
|
|
|
|
|
From
To |
|
|
|
|
|
|
From
To |
|
|
|
|
|
REFERENCES:
Give below the names of three persons not related to you whom you
have known at least one year (preferably
in the teaching profession).
|
Name |
Address |
Phone
# |
Occupation |
Years
Acquainted |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
CANDIDATE'S
STATEMENT:
Each
candidate is required to provide in handwritten form on a separate
sheet of paper, any additional information that will
assist the district in evaluating the candidate's qualifications
(i.e., personal qualities, educational philosophy, future goals,
awards, travel, involvement in community activities, etc.)
Statements
should be limited to about 100 words.
CERTIFICATION:
I hereby certify that the information given by me in this
application is true, correct and complete; and, I hereby authorize
personnel in the district to examine my records and contact any of
my schools, former employers, education, certification, experience
and fitness as a teacher, and I agree to hold any and all of such
references harmless and free of any liability for releasing any
truthful information about me.
I understand that failure to provide employment or employer history
requested in this application which is material to my qualifications
for employment as a teacher or the provision of statements which I
do not believe to be true may be a Class A misdemeanor. For purposes
of this application, I shall be deemed to have made a false
statement if I make a statement which I do not believe to be true or
if I knowingly omit or fail to include any employment or employer
history required to be furnished on this application.
I understand that if I am employed, any false or misleading
statement made or implied on this application, any omission herefrom,
or any inconsistency between the information I have provided herein
and information obtained from any criminal history records check,
Statewide Sex Offender Database check, Statewide Child Murderer and
Violent Offender Against Youth Database check, or background
investigation is sufficient cause for dismissal.
_________________________________
______________________________
Signature
Date
APPLICATIONS
REMAIN ACTIVE FOR ONE YEAR-REAPPLICATION IS NECESSARY
AFTER THAT
TIME
Do
not write below this line
Date
of Interview_____________ Time__________ Interviewed
by:_____________
Remarks___________________________________________________________
__________________________________________________________________
__________________________________________________________________
|