CERTIFIED STAFF APPLICATION (Must Be Completed in Full)

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1 For Office Use Only: School Site: Hire Date: ID Assigned: Position: Replaced: CERTIFIED STAFF APPLICATION (Must Be Completed in Full) This application will remain active for two full years from the date submitted. Please include a copy of your college/university transcripts, teaching certificate/license, and updated resume. To keep your application active, contact Glenpool Public School s Personnel Director prior to the two year expiration date. Application Date PERSONAL INFORMATION Name Last First Middle Mailing Address City State Zip Address Date of Birth Primary Phone Number Cell Home Work Secondary Phone Number Cell Home Work Emergency Contact: Name Relationship Phone Number CERTIFICATION INFORMATION None Testing Completed Successfully Date license application was filed: Valid Out-of-State Certificate Date Oklahoma certification application was filed: Valid Oklahoma License Expiration Date Certificate Number Valid Oklahoma Provisional Certificate Expiration Date Valid Standard Oklahoma Certification Expiration Date Certificate Number Certificate Number Areas of Certification: Complete the form on the last page indicating all areas in which you are certified to teach. Grade/Specialty Preference: Administrator Early Childhood (PK & KG) Lower Elementary (1 st & 2 nd ) Upper Elementary (3 rd 5 th ) Middle School (6 th 8 th ) High School (9 th 12 th ) Art Music PE Library/Media School Nurse Special Education Interested in Sponsoring/Coaching: Academic Team Baseball Basketball M or F Cheerleading Cross Country M or F Football Golf M or F Honor Society Soccer M or F Softball Student Council Track M or F Volleyball Wrestling Yearbook

2 PROFESSIONAL PREPARATION High School (Institution) City/State Graduation Date Baccalaureate Degree (Institution) City/State Graduation Date Master s Degree (Institution) City/State Graduation Date Doctorate (Institution) City/State Graduation Date Undergraduate: Graduate: Major Area Minor Area Major Area Minor Area Graduate Hours Above Highest Degree: Institution TEACHING EXPERIENCE District & School Name City State Grade(s) / Subject(s) Taught From / To / Principal/Supervisor s Name District & School Name City State Grade(s) / Subject(s) Taught From / To / Principal/Supervisor s Name District & School Name City State Grade(s) / Subject(s) Taught From / To / Principal/Supervisor s Name District & School Name City State Grade(s) / Subject(s) Taught From / To / Principal/Supervisor s Name Total Years in Oklahoma* + Total Years Out-of-State (5 max) + Military Service (5 max) Total Creditable Years Teaching *Only Public or Accredited Private School Experience

3 REFERENCES Please include three professional and two personal references. Professional Personal

4 GENERAL INFORMATION 1. Are you currently under contract? No 2. If under contract, have you discussed your release with your current employer? No Yes 3. If under contract, what is the first date you would be available for employment? mm dd yyyy 4. Are you aware of any reason you would not be able to perform the essential responsibilities of the position for which you are making application? No Yes please explain: 5. Do you have a relative who is currently employed at Glenpool Public Schools or who is a member of the Glenpool Board of Education? No Yes please explain: 6. Have you ever been convicted of a felony or misdemeanor other than a traffic violation? No Yes please explain: 7. Have you ever been dismissed from employment with a public school or your contract non-renewed at the conclusion of a school term? No Yes please explain: 8. Please explain any gaps in employment which exceed 30 days in duration. CONDITIONS OF EMPLOYMENT Any candidate who is offered employment with Glenpool Public Schools understands and agrees to the following conditions of employment: 1. Must provide authorization for a felony record search. 2. Must sign annual criminal record questionnaire and be subject to annual random criminal background checks. Smoking and/or the Use of Other Tobacco Related Products is Prohibited in ALL School Facilities and on ALL School Grounds.

5 Please write a statement listing what you consider to be your major strengths as an educator and how the application of these strengths would be of benefit to the students in your classes. ***If you are applying for an Administrator position or a Special Education position, please fill out the appropriate supplemental questions on the following pages.*** I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge. I also understand that an employment contract based upon information contained in this application which later proves to be false or incomplete shall result in withdrawal of offer of employment or contract becoming null and void. Glenpool Public Schools is authorized to contact all persons, firms, and entities listed in this application or related papers and/or others who are/were in a position to provide information relevant to the consideration of employment of this applicant. Such persons, firms, and entities are hereby authorized to release any information or records concerning me to the Glenpool School District and I hereby release said persons, firms, and entities from any/all liability as a result of their providing such information or records. Signature of Applicant Date Please Transcript(s), copy of Teaching Certification, and Resume to Meleah Bryant: If you don t have access to a scanner you may mail or hand deliver Transcript(s), copy of Teaching Certification, and Resume to: Glenpool Public Schools Meleah Bryant 461 East 146 th Street P.O. Box 1149 Glenpool, Oklahoma NOTE: Applicant will not be notified of receipt of completed application. If receipt is in question, contact the school to verify receipt at after sufficient time has elapsed. Glenpool School District does not discriminate on the basis of race, color, national origin, gender, age, or qualified handicap.

6 ADMINISTRATOR APPLICANT SUPPLEMENTAL QUESTIONNAIRE This supplement to the standard application will permit the applicant to express his/her position on issues considered important to an administrative position with Glenpool Schools. Please answer each question as clearly and as concisely as possible. Please relate each response to the administrative position for which you are applying. Attach additional paper if needed. Applying for the position of: Please list previous administrative experience (responsibilities, locations, and length of service in each position). 1. Describe your preferred leadership style. (Explain or give short examples.) 2. Please list what you consider to be the five most important characteristics of an exceptional teacher. 3. Please state your philosophy regarding student discipline and cite methods of discipline that you have used effectively or that you feel would be effective in modifying behavior. 4. Define curriculum and instruction. What would be your role in regard to these vital educational components? What would be your first action regarding curriculum and instruction?

7 5. Please share the role you would take in the following five areas of curriculum and instruction: A. Academic Standards B. Data driven decision making C. Teaching D. Assessment of student learning E. Professional Development 6. Regarding curriculum and instruction, how would you lead your building in creating high expectations for students and determining if they are adequately prepared to exit high school?

8 SPECIAL EDUCATION APPLICANT SUPPLEMENTAL QUESTIONNAIRE 1. What is your philosophy in regard to education for children with disabilities? 2. What is your definition of least restrictive environment? 3. What is your definition of inclusion? 4. What roles does the special educator play in providing the least restrictive environment for students with disabilities? 5. List the materials, techniques, and assessment instruments you would use in establishing your program for elementary/middle/secondary. (Circle one.) 6. What would you do to enhance and maintain your expertise in the field of special education?

9 AREAS OF CERTIFICATION (CHECK APPROPRIATE BOXES) 0500 PROFESSIONAL SCHOOL SERVICES 0501 Superintendent 0502 Elem. Superintendent 0503 Secondary Principal 0504 Middle Level Principal 0505 Elementary Principal 0507 Vocational Administrator 0509 Audio/Visual Specialist 0511 Census & Attendance 0513 Librarian 0515 Library Media Specialist 0517 School Psychologist 0519 School Psychometrist 0521 Speech Language Path Speech Pathologist 0524 Elementary Counselor 0525 School Counselor 0526 Secondary Counselor 0531 Curriculum Administrator 1000 ELEMENTARY EDUCATION 1001 Early Childhood 1002 Spec. Ed. Kindergarten 1003 Early Childhood 1004 Four-Year-Olds & Younger 1501 Elementary Education 2000 ELEMENTARY- SECONDARY EDUCATION 2001 Art 2002 American Sign Language 2003 French 2004 Japanese 2005 German 2006 Russian 2007 Latin 2008 Italian 2009 Other Foreign Language 2010 Native Amer. Language 2011 Spanish 2012 Chinese 2013 Music-Instrumental 2014 Music Theory 2015 Music-Vocal 2016 Turkish 2017 Health 2018 Greek 2019 PE/Health/Safety 2020 Dance 2021 Reading Specialist 2025 Cherokee 2027 Choctaw 2030 Kiowa 2075 Art Jr. High 2085 Music Jr. High 2090 PE Jr. High 2500 SPECIAL EDUCATION 2501 Emotionally Disturbed 2503 Hearing Impaired 2505 Learning Disability 2507 Mentally Handicapped 2509 Physically Handicapped 2511 Visually Handicapped 2550 Blind/Visual Impairment 2552 Deaf/Hard of Hearing 2556 Mild-Moderate Disabilities 2558 Severe-Profound 3500 BUSINESS 3501 Accounting 3503 Business English 3505 Business Law 3507 Business Machines 3509 Business Math 3511 Career/Occup Inform 3513 Comp in Bus/Info Pro 3515 Economics 3517 Finance 3519 General Business 3521 Management 3523 Marketing 3525 Office Proc/Manage 3527 Shorthand 3529 Typewriting 3550 Business Education 3700 FOREIGN LANGUAGE 3701 French 3703 German 3705 Latin 3709 Russian 3711 Spanish 4000 ENGLISH / LANG.ARTS 4001 American Literature 4003 English Literature 4005 Grammar & Composition 4007 Journalism 4009 Library Science 4011 Newspaper 4013 Speech & Drama 4015 World Literature 4017 Yearbook 4075 Language Arts Jr. High 4500 HOME ECONOMICS 4501 Home Economics 4503 Adult/Family Living 4505 Career Education 4507 Child Dev/Parent Ed 4509 Consumer Education 4511 Nutrition Education 4513 Textiles/Clothing 4550 Family & Consumer Sci 5000 INDUSTRIAL ARTS 5001 Drafting Technology 5003 Electric/Electronics 5005 Gen Industrial Arts 5007 Graphics 5009 Metal Technology 5011 Power Technology 5013 Wood Technology 5500 MATHEMATICS 5501 Algebra 5503 Analysis 5505 Calculus 5507 Computer Science/App 5509 General Mathematics 5511 Geometry 5513 Linear Algebra 5515 Statistics 5517 Trigonometry 5550 Advanced/Sec Math 5552 Intermediate Math 5575 Math Jr. High 6000 SCIENCE 6001 Anatomy/Physiology 6003 Biology 6005 Botany 6006 Chemistry 6007 Computer Applications 6009 Earth Science 6011 General Science 6013 Physical Science 6015 Physics 6017 Zoology 6050 Biological Sciences 6075 Science Jr. High 6500 SOCIAL STUDIES 6501 American History 6503 Ancient/Medieval History 6505 Black History 6507 Conserv Nat Resources 6509 Democracy 6511 Economics 6513 Geography 6515 International Problems 6517 Oklahoma History 6519 Sociology/Anthropology 6521 U.S. Government 6523 World History 6550 U.S History/OK History/ Government/Economics 6552 World Hist/Geography 6554 Psychology/Sociology 6575 Social Studies Jr. High 7000 SPECIALIZED SERVICE 7001 Occupational Therapy 7003 Physical Therapy 7005 School Nurse 7500 CAREER & TECH EDU 7501 Marketing 7503 Occupational Agriculture 7505 Occupational Home Econ 7507 Technical Education 7509 Trade and Industrial 7511 Vocational Agriculture 7513 Vocational Business 7514 Career & Tech Business 7515 Career & Tech Health 7517 Vocational Home Econ 7550 Agriculture Education 7559 Occupational Family & Consumer Science 7575 Career & Tech Family & Consumer Science 8000 SPECIAL ENDORSEMENTS 8001 Aeronautics 8003 Athletic Coach 8005 Bilingual/Multiculture 8007 Computer Science 8009 Driver/Safety Education 8011 Eng as a Second Lang 8013 Psychology 8015 ROTC 8017 Gifted and Talented 8019 Elem Keyboarding 8021 Curriculum Supervisor 8500 TECHNOLOGY EDU 8501 Gen Tech Enginering 8503 Communication Tech 8505 Construction Tech 8507 Manufacturing Tech 8509 Eng/Pwr/Transp Tech 8550 Tech Engineering 8575 Tech Engineering Jr. High 9800 SPECIAL ED REGISTRIES 9801 Autism 9802 Deaf-Blindness 9803 Multiple Disabilities 9804 Other Health Impairment 9805 Traumatic Brain Injury

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