Certified Teacher Application

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Certified Teacher Application"

Transcription

1 UNITED COMMUNITY SCHOOLS Certified Teacher Application PERSONAL INFORMATION Title: First Name: Middle Initial: Last Name: Social Security Number: Address: City: State: Zip Code: Home/Contact Phone: AREAS OF INTEREST General Education Positions (Please identify in numerical order the preferred level(s) and preferences or list the positions from the Teach Iowa Website: Special Education Positions and Related Services, please specify exceptionalities and certification: ESL Endorsement: YES NO Bilingual Endorsement: YES NO

2 Sport or Student Activity you would feel qualified to coach or sponsor: List special strengths, talents and/or unique qualities you possess which you believe might be useful in your employment, including any sign language skills or training: PROFESSIONAL EDUCATION/QUALIFICATIONS Major Minor University Date Completed AA/Other BA/BS MA/MS/Med Ed.S./Ph.D Full Time Teaching/Clinical/Internship Experience Under Contract and Credentialed Date Grade/Subject Location School Names/Phone Number Certificates Now Held or Applied For (including out of State): Type: State: Minor: Expires: If applied for Iowa Certificate, please list folder number: Endorsements/Clinical/Licenses Type(s): State: Expires: Student Teaching/Clinical/Intern Experience Date Grade/Subject Location School Names/Phone Number

3 Other Work Experience(s) and Dates: Do you possess an Iowa teaching certification/endorsement? YES NO If No, have you applied for an Iowa teaching certification/endorsement? YES NO Apply for Iowa Licensure at: PERSONAL DATA Date Available for Employment Are you under a teaching contract for next year? YES NO If YES, where? Have you successfully completed an official probationary period in a public school district? YES NO If YES, what was the length of the probationary period? Have you successfully completed a mentoring and induction program? YES NO If YES, when? Are you able to perform, with or without reasonable accommodation, the essential job functions required of this position? YES NO If NO, please explain: Are you available full time? YES NO Are you willing to consider less than full time? YES NO Have you served in the military? YES NO If YES, I served in these wars and/or conflicts: Have you ever been denied a teaching certificate/license or had your teaching certificate/license suspended or revoked? YES NO If YES, Check the action taken: denied suspended revoked Which State(s)? Are you on a sex offender registry? YES NO Are you on the Department of Human Services' child abuse registry? YES NO

4 Have you ever been convicted of a felony or misdemeanor (excluding traffic violations)? YES NO If YES, please provide date, incident, city/state of charge: Responding "yes" to any of the previous questions is not an automatic bar to employment. The date of the offense, and the relationship between the offense and the position for which you are applying will be considered. Special Skills or Interests: Other subjects you are credentialed to teach, activities qualified to direct, sports qualified to coach or positions qualified to fill: Please specify any language (other than English) that you are proficient in: Professional References (Include a minimum of three who have knowledge of your professional/teaching experiences): Make sure to include the Name, Position, and Address/Telephone Number of each reference. Are you legally authorized to work in the United States of America? YES NO

5 AUTHORIZATION AND RELEASE I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION ALL RELATED INFORMATION WHICH I HAVE PROVIDED ARE TRUE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. YES NO I EXPRESSLY AUTHORIZE THE RELEASE TO THE EDUCATIONAL AGENCY RECEIVING THIS APPLICATION ANY RECORDS OR INFORMATION WHICH MAY REFER OR RELATE TO THIS APPLICATION FOR EMPLOYMENT, INCLUDING, BUT NOT LIMITED TO, RECORDS OF EDUCATIONAL INSTITUTIONS, LAW ENFORCEMENT OR CRIMINAL JUSTICE AGENCIES, AGENCIES MAINTAINING CHILD ABUSE RECORDS, AND PREVIOUS EMPLOYERS. I HEREBY RELEASE AND DISCHARGE THE EDUCATIONAL AGENCY RECEIVING THIS APPLICATION AND ANY RESPONSIBLE PERSON(S) EMPLOYED BY THE AGENCY FROM ANY AND ALL CLAIMS AND LIABILITY WHICH I MAY HAVE OR EVER CLAIM TO HAVE RELATING TO INFORMATION PROVIDED TO THE EDUCATIONAL AGENCY AS PART OF THIS APPLICATION FOR EMPLOYMENT. YES NO Signature of Applicant At the time of the personal interview the Applicant will be asked to sign any needed and necessary releases as a part of the interview process and/or employment. The interviewing Educational Agency may forward the Applicant Authorization and Release forms as a part of the interviewing process. Date NAME SIGNATURE

Armstrong Ringsted Community School District

Armstrong Ringsted Community School District Armstrong Ringsted Community School District 400 4 th Street Armstrong, Iowa 50514 (712) 868 3542 www.armstrong.k12.ia.us APPLICATION FOR EMPLOYMENT Name: Social Security # (Last) (First) (Middle Initial)

More information

Orion Community Unit School District 223

Orion Community Unit School District 223 Orion Community Unit School District 223 ORION, ILLINOIS Application Date: Position Applying for: Name: Social Security # Email: U.S. Citizen? Are you legally eligible to work in the United States? Home

More information

PERSONNEL SERVICES Form 4120 Employment Employment Application - Certificated Staff LAQUEY R-V APPLICATION FOR A CERTIFICATED POSITION

PERSONNEL SERVICES Form 4120 Employment Employment Application - Certificated Staff LAQUEY R-V APPLICATION FOR A CERTIFICATED POSITION PERSONNEL SERVICES Form 4120 Employment Employment Application - Certificated Staff LAQUEY R-V APPLICATION FOR A CERTIFICATED POSITION The School District considers applicants for all positions without

More information

LA PLATA R-II SCHOOL DISTRICT 201 W. Moore Street La Plata, MO 63549 Phone: 660-332-7001 Application For A Certificated Position

LA PLATA R-II SCHOOL DISTRICT 201 W. Moore Street La Plata, MO 63549 Phone: 660-332-7001 Application For A Certificated Position 1 LA PLATA R-II SCHOOL DISTRICT 201 W. Moore Street La Plata, MO 63549 Phone: 660-332-7001 Application For A Certificated Position The La Plata R-II School District considers applicants for all positions

More information

San Luis Coastal Unified School District 1500 Lizzie Street, San Luis Obispo, CA 93401 (805) 549-1235 WE ARE AN EQUAL OPPORTUNITY EMPLOYER

San Luis Coastal Unified School District 1500 Lizzie Street, San Luis Obispo, CA 93401 (805) 549-1235 WE ARE AN EQUAL OPPORTUNITY EMPLOYER San Luis Coastal Unified School District 1500 Lizzie Street, San Luis Obispo, CA 93401 (805) 549-1235 WE ARE AN EQUAL OPPORTUNITY EMPLOYER \ Thank you for your interest in working as a BILINGUAL substitute

More information

EMPLOYMENT APPLICATION CERTIFIED TEACHER

EMPLOYMENT APPLICATION CERTIFIED TEACHER EMPLOYMENT APPLICATION CERTIFIED TEACHER A. APPLICANT INFORMATION (please print) Full name: Last First Middle Address: Street City, state ZIP code Phone: ( ) ( ) Home Cell E-mail: B. POSITION DESIRED Position

More information

CERTIFIED TEACHER APPLICATION INSTRUCTIONS

CERTIFIED TEACHER APPLICATION INSTRUCTIONS School City of Whiting 1500 Center Street, Whiting, IN 46394 Phone: 219-659-0656 Fax: 219-473-4008 www.whiting.k12.in.us CERTIFIED TEACHER APPLICATION INSTRUCTIONS The completed employment application

More information

APPLICATION FOR CERTIFIED PERSONNEL INSTRUCTIONS

APPLICATION FOR CERTIFIED PERSONNEL INSTRUCTIONS Sponsored by Brothers of Holy Cross GILMOUR ACADEMY 34001 CEDAR ROAD GATES MILLS, OHIO 44040-9356 (440) 442-1104 GILMOUR ACADEMY Founded 1946 GLEN OAK SCHOOL Founded 1969 APPLICATION FOR CERTIFIED PERSONNEL

More information

4169 PRUDEN BLVD. SUFFOLK VA 23434 (757) 925-5651 FAX (757) 925-5639 WEBSITE: www.prudencenter.net APPLICATION FOR PROFESSIONAL EMPLOYMENT

4169 PRUDEN BLVD. SUFFOLK VA 23434 (757) 925-5651 FAX (757) 925-5639 WEBSITE: www.prudencenter.net APPLICATION FOR PROFESSIONAL EMPLOYMENT 4169 PRUDEN BLVD. SUFFOLK VA 23434 (757) 925-5651 FAX (757) 925-5639 WEBSITE: www.prudencenter.net APPLICATION FOR PROFESSIONAL EMPLOYMENT Applicant s Full Name LAST FIRST MI MAIDEN NAME Other Name(s)

More information

Application For Teaching or Administrative Position. Mail completed application to: Gatewood Schools. 139 Phillips Drive Eatonton, Georgia 31024

Application For Teaching or Administrative Position. Mail completed application to: Gatewood Schools. 139 Phillips Drive Eatonton, Georgia 31024 Application For Teaching or Administrative Position Mail completed application to: Gatewood Schools 139 Phillips Drive Eatonton, Georgia 31024 Date: Name: Phone: Email address: Cell Phone: Address: (Number

More information

Accelerated Teacher Certification Program APPLICATION

Accelerated Teacher Certification Program APPLICATION HCC STUDENT ID (Emplid): TEA ID: Please check the certificate area applying for: Bilingual Education Supplemental-Spanish (t a standalone certificate) Bilingual Generalist-Spanish (EC-6) English as a Second

More information

LICENSING AT A LOWER LEVEL

LICENSING AT A LOWER LEVEL EMS-APP-500 (11/2014) Michigan Department of Community Health Lansing, Michigan 48909 Website: www.michigan.gov/ems Authority: P.A. 368 of 1978, as amended This form is for information only. MICHIGAN COURSE

More information

Personal Information

Personal Information Forsyth R-III School District P.O. Box 187 Forsyth, MO 65653 Phone: 417-546-6384 Fax: 417-546-2204 Certified Personnel Employment Application Personal Information Last Name First Middle Date Street City,

More information

APPLICATION FOR RENEWAL OF A MASTER EDUCATOR LICENSE

APPLICATION FOR RENEWAL OF A MASTER EDUCATOR LICENSE Attach check or money order DO NOT SEND CASH APPLICATION FOR RENEWAL OF A MASTER EDUCATOR LICENSE (Note: You may not renew your license earlier than one year from its expiration date.) Board of Educational

More information

PARKERSBURG POLICE DEPARTMENT

PARKERSBURG POLICE DEPARTMENT PARKERSBURG POLICE DEPARTMENT Parkersburg, West Virginia EMPLOYMENT APPLICATION HONOR PRIDE DUTY Since 1873 The City of Parkersburg is an equal opportunity employer. Revised 3-13-12 Page 1 Position: PARKERSBURG

More information

Teacher Application NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER PRESENT ADDRESS STREET PERMANENT ADDRESS E-MAIL ADDRESS EDUCATIONAL BACKGROUND

Teacher Application NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER PRESENT ADDRESS STREET PERMANENT ADDRESS E-MAIL ADDRESS EDUCATIONAL BACKGROUND Teacher Application NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER PRESENT ADDRESS STREET (AREA CODE) TELEPHONE CITY STATE ZIP CODE PERMANENT ADDRESS STREET (AREA CODE) TELEPHONE CITY STATE ZIP CODE E-MAIL

More information

EMPLOYMENT APPLICATION. Position(s) for which you are applying: Date: Personal Information. Legal Name: Last First Middle Maiden.

EMPLOYMENT APPLICATION. Position(s) for which you are applying: Date: Personal Information. Legal Name: Last First Middle Maiden. Effort Christian School and Preschool A ministry of Effort Baptist Church 7829 Thomas Jefferson Parkway Palmyra, Virginia 22963 434-589-8962 www.effortchristianschoolandpreschool.com Your interest in Effort

More information

Dear Applicant: In order to have a complete file you must submit:

Dear Applicant: In order to have a complete file you must submit: Dear Applicant: Thank you for your interest in teaching for the Norwood School District. Enclosed is our District Application and information about the Norwood School District. Applications for teaching

More information

Michael Gayoso, Jr. Office of the County Attorney TH

Michael Gayoso, Jr. Office of the County Attorney TH Michael Gayoso, Jr. Office of the County Attorney TH 11 Judicial District/Crawford County, Kansas DIVERSION PROGRAM -- DRIVING UNDER THE INFLUENCE Pursuant to K.S.A. 22-2906 et seq. the Crawford County

More information

TEACHING APPLICATION

TEACHING APPLICATION TEACHING APPLICATION The Creating Landscapes Learning Center 640 Walnut Street, Meadville PA 16335 Position Desired Name Last First Middle Social Security Number Current Address Street City State Zip Code

More information

Iowa Administrator certificate? Yes No. Doctorate

Iowa Administrator certificate? Yes No. Doctorate CLINTON COMMUNITY SCHOOLS APPLICATION FOR 1401 12 th Ave. N. MIDDLE SCHOOL PRINCIPAL Clinton, Iowa 52733-2956 (563)243-0463 FAX: (563)243-0493 www.clinton.k12.ia.us DATE OF APPLICATION: FULL NAME: Last

More information

Application for Employment

Application for Employment Application for Employment GENERAL INFORMATION (Please Print) Name: Telephone No.: LAST FIRST MIDDLE Email Address: Present Address: Position Desired: STREET CITY STATE ZIP Pay Desired: If hired, can you

More information

NURSE PRACTITIONER/PHYSICIANS ASSISTANT APPLICATION GENERAL INFORMATION. Last Name First Middle. Place of Birth Social Security #

NURSE PRACTITIONER/PHYSICIANS ASSISTANT APPLICATION GENERAL INFORMATION. Last Name First Middle. Place of Birth Social Security # Page 1 NURSE PRACTITIONER/PHYSICIANS ASSISTANT APPLICATION GENERAL INFORMATION Last Name First Middle Place of Birth Social Security # Home Address City State Zip Office Address City State Zip DOB Emergency

More information

SCHOOL DISTRICT OF SEWARD Application for: 410 South Street Seward, Nebraska Fax: Personnel Phone:

SCHOOL DISTRICT OF SEWARD Application for: 410 South Street Seward, Nebraska Fax: Personnel Phone: SCHOOL DISTRICT OF SEWARD Application for: 410 South Street Seward, Nebraska 68434 Certified Fax: 402-643-4986 Personnel Phone: 402-643-2941 Application Date: Name: Last First Middle Present Address: Other

More information

First Middle Last. Number and Street City State Zip Code Home Telephone # Work Telephone #

First Middle Last. Number and Street City State Zip Code Home Telephone # Work Telephone # EMPLOYMENT APPLICATION Fire Department City of Sterling, Colorado 421 N. 4 th St., P.O. Box 4000 Sterling, CO 80751-0400 Phone (970) 522-9700 FAX (970)521-0632 www.sterlingcolo.com An Equal Opportunity

More information

STANDARD APPLICATION For Teaching Positions in Pennsylvania Public Schools

STANDARD APPLICATION For Teaching Positions in Pennsylvania Public Schools STANDARD APPLICATION For Teaching Positions in Pennsylvania Public Schools (PLEASE PRINT OR TYPE) POSITION(S) DESIRED NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER 1 PRESENT ADDRESS STREET (AREA CODE)

More information

South Texas Lighthouse for the Blind. California Employment Application

South Texas Lighthouse for the Blind. California Employment Application South Texas Lighthouse for the Blind Main Office: P. O. Box 9697 Ph. 888-255-8011 Corpus Christi, TX 78469 Fax 361-883-1041 South Texas Lighthouse for the Blind is an Equal Opportunity and Affirmative

More information

Consultant Application

Consultant Application Consultant Application Education Service Center Region 12 2101 W. Loop 340 Waco, Texas 76712 254-297-1212 254-666-0625 The Education Service Center Region 12 does not discriminate on the basis of race,

More information

Accelerated Teacher Certification Program APPLICATION

Accelerated Teacher Certification Program APPLICATION Complete this program application and submit (with signature) to atcp@hccs.edu or mail/deliver to ATCP Department Office. HCC STUDENT ID (Emplid): Please check the certificate area(s) applying for: Elementary

More information

WEST LIBERTYCOMMUNITY SCHOOL DISTRICT Nurse Application for Employment

WEST LIBERTYCOMMUNITY SCHOOL DISTRICT Nurse Application for Employment WEST LIBERTYCOMMUNITY SCHOOL DISTRICT Nurse Application for Employment FULL NAME LAST FIRST MIDDLE INITIAL DATE OTHER NAME(S) PLEASE PROVIDE ANY OTHER NAMES YOU HAVE USED AT ANY TIME CURRENT ADDRESS STREET

More information

WISH Charter School Employment Application

WISH Charter School Employment Application WISH Charter School Employment Application POSITION DESIRED: APPLICATION REQUIREMENTS (*Teachers Only) Application Form and Resume Formal Letter of Interest Three Letters of Reference Copy of Transcripts

More information

Nursing Scholarship Application

Nursing Scholarship Application Nursing Scholarship Application Name: Semester: Year: Trinity Health offers many nursing scholarships each year. Any student who is accepted into a North Dakota nursing program is eligible to apply for

More information

Renewal Application Instructions & Requirements

Renewal Application Instructions & Requirements Certification Office 800 Governors Drive Pierre, South Dakota 57501 certification@state.sd.us Telephone: 605.773.3426 Renewal Application Instructions & Requirements Five-year renewal All credits must

More information

CHENANGO FORKS CENTRAL SCHOOL DISTRICT

CHENANGO FORKS CENTRAL SCHOOL DISTRICT CHENANGO FORKS CENTRAL SCHOOL DISTRICT Teacher Application of (your name) for a Teaching Position in the CHENANGO FORKS CENTRAL SCHOOL DISTRICT Binghamton, New York 13901 Position Applied For: Date Submitted:

More information

Ritter Plumbing Co., Inc. Application for Employment (An Equal Opportunity Employer)

Ritter Plumbing Co., Inc. Application for Employment (An Equal Opportunity Employer) Ritter Plumbing Co., Inc. Application for Employment (An Equal Opportunity Employer) In compliance with Federal and State equal employment opportunity laws, Ritter Plumbing Co., Inc does not discriminate

More information

BEXAR APPRAISAL DISTRICT 411 NORTH FRIO, SAN ANTONIO, TEXAS 78207 APPLICATION FOR EMPLOYMENT

BEXAR APPRAISAL DISTRICT 411 NORTH FRIO, SAN ANTONIO, TEXAS 78207 APPLICATION FOR EMPLOYMENT BEXAR APPRAISAL DISTRICT 411 NORTH FRIO, SAN ANTONIO, TEXAS 78207 APPLICATION FOR EMPLOYMENT BEXAR APPRAISAL DISTRICT IS AN EQUAL OPPORTUNITY EMPLOYER Applicants are considered for all positions without

More information

ZipCare Transportation, LLC

ZipCare Transportation, LLC Application for Employment ZipCare Transportation, LLC 763 S. New Ballas Rd. Suite 300 St. Louis, MO 63141 Phone: 314-292-7302 Comments/Additional Notes: 1 ZCT (06/13) EMPLOYMENT APPLICATION PERSONAL Last

More information

TEXAS DEPARTMENT OF STATE HEALTH SERVICES RESPIRATORY CARE PRACTITIONERS CERTIFICATION PROGRAM (512) 834-6632 APPLICATION INFORMATION

TEXAS DEPARTMENT OF STATE HEALTH SERVICES RESPIRATORY CARE PRACTITIONERS CERTIFICATION PROGRAM (512) 834-6632 APPLICATION INFORMATION TEXAS DEPARTMENT OF STATE HEALTH SERVICES RESPIRATORY CARE PRACTITIONERS CERTIFICATION PROGRAM (512) 834-6632 APPLICATION INFORMATION An incomplete application will not be processed until all required

More information

PROFESSIONAL APPLICATION

PROFESSIONAL APPLICATION OUR MISSION The mission of Northmont City Schools is to provide students an exceptional education with diverse opportunities so they maximize their potential and are productive, responsible citizens. NORTHMONT

More information

APPLICATION FOR REINSTATEMENT OF NURSE AIDE CERTIFICATION

APPLICATION FOR REINSTATEMENT OF NURSE AIDE CERTIFICATION THE STATE of ALASKA Department of Commerce, Community, and Economic Development Nurse Aide Registry 550 West 7 th Avenue, Suite 1500 Anchorage, AK 99501 Phone: (907) 269-8169 Fax: (907) 269-8196 Email:

More information

Employment Application Process For Classified (Non-licensed) Applicants

Employment Application Process For Classified (Non-licensed) Applicants Pascagoula School District Human Resources Department 1006 Communy Avenue P. O. Box 250 Pascagoula, MS 39568-0250 (228) 938-6506 FAX (228) 938-6507 Employment Application Process For Classified (Non-licensed)

More information

MONTGOMERY YMCA APPLICATION FOR EMPLOYMENT

MONTGOMERY YMCA APPLICATION FOR EMPLOYMENT RETURN TO BRANCH: MONTGOMERY YMCA APPLICATION FOR EMPLOYMENT YMCA Mission To put Christian principles into practice through programs that build a healthy body, mind and spirit for all. Equal Opportunity

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION 301 Church Avenue, Knoxville TN 37915 APPLICANT INSTRUCTIONS: If you need assistance filling out this application form please contact KAT at (865) 215-7800. 1. Please read "APPLICANT NOTE" below. 2. Complete

More information

PLEASE PRINT USING BLUE OR BLACK INK PERSONAL PROFILE

PLEASE PRINT USING BLUE OR BLACK INK PERSONAL PROFILE PLEASE PRINT USING BLUE OR BLACK INK Date: 5/4/ PERSONAL PROFILE ***All positions are for one year (September 1, to August 16, 2016). You must be able to complete the full year of service to receive educational

More information

Eastern Region HR Great Circle 330 North Gore Webster Groves, MO 63119 Phone: (314)968-2060 Fax: (314)968-8308 Email: Rebecca.Brenner@greatcircle.

Eastern Region HR Great Circle 330 North Gore Webster Groves, MO 63119 Phone: (314)968-2060 Fax: (314)968-8308 Email: Rebecca.Brenner@greatcircle. Please mail, email or fax your application to one or more of the following locations, according to which job(s) or location(s) you are interested in joining. Eastern Region HR 330 North Gore Webster Groves,

More information

Employment Application

Employment Application Employment Application APPLICANT INFORMATION Last Name First M.I. Date Street Apartment/Unit # City State ZIP Phone Date Available Social Security No. E-mail Position Applied for Are you a citizen of the

More information

CPA or LPA Firm Permit Renewal Application. RENEW ONLINE AT: www.licensediniowa.gov PEER REVIEW

CPA or LPA Firm Permit Renewal Application. RENEW ONLINE AT: www.licensediniowa.gov PEER REVIEW CPA or LPA Firm Permit Renewal Application July 1, 2016 through June 30, 2017 INDICATE FIRM NAME AND MAILING ADDRESS BELOW: Firm Name: Address: Street City State Zip RENEW ONLINE AT: www.licensediniowa.gov

More information

Department of Education Alternative Route to Certification Program Application

Department of Education Alternative Route to Certification Program Application Certification Office 800 Governors Drive Pierre, South Dakota 57501 certification@state.sd.us Telephone: 605.773.3426 Department of Education Alternative Route to Certification Program Application Instructions

More information

Please Print in Ink or Type NOTE: Some positions may require a TB Test and/or Tetanus Shot. Present Address -

Please Print in Ink or Type NOTE: Some positions may require a TB Test and/or Tetanus Shot. Present Address - An Equal Opportunity Employer Where did you learn about our Job Openings? Zoo Employment Web Page Family Member Friend College Employment Web Page College Job Fair Craig s List Radio Announcement Zoo News

More information

FIRE FIGHTER APPLICATION PACKAGE

FIRE FIGHTER APPLICATION PACKAGE FIRE FIGHTER APPLICATION PACKAGE APPLICATION CLOSING DATE AND LOCATION: TUESDAY, NOVEMBER 8, 2011 AT 5:00 P.M. (CENTRAL STANDARD TIME) HUMAN RESOURCES DEPARTMENT 1110 HOUSTON STREET, LAREDO, TEXAS 78042

More information

FIREFIGHTER RECIPROCITY PACKET

FIREFIGHTER RECIPROCITY PACKET OHIO DEPARTMENT OF PUBLIC SAFETY FIREFIGHTER RECIPROCITY PACKET A candidate seeking firefighter certification through reciprocity shall meet all of the following criteria: Shall have successfully completed

More information

NORTH STAR CHARTER SCHOOL

NORTH STAR CHARTER SCHOOL Employment Application Certified Teacher North Star Charter School is committed to providing equal employment opportunities for all candidates without regard to race, creed, color, national origin, sex,

More information

( ) ( ) City State Zip Code Phone Number Work Phone

( ) ( ) City State Zip Code Phone Number Work Phone DAVIS APPLIED TECHNOLOGY COLLEGE A Utah College of Applied Technology Campus 550 East 300 South, Kaysville, Utah 84037-2699 Ph (801) 593-2326 FAX (801) 546-4824 mark.jeppesen@datc.edu Application may be

More information

There is no position in education as powerful as the principal for making a difference for students, families, and communities.

There is no position in education as powerful as the principal for making a difference for students, families, and communities. There is no position in education as powerful as the principal for making a difference for students, families, and communities. Dr. Joseph Murphy Chair, Interstate School Leaders Licensure Consortium (ISLLC)

More information

Date of Application: Social Security Number: - -

Date of Application: Social Security Number: - - La Feria Independent School District P.O. Box 1159 203 E. Oleander La Feria, Texas 78559 (956) 797-2612 FAX (956) 797-3737 Raymundo P. Villarreal Jr., Superintendent Employment Application for Service

More information

ADULT VOLUNTEER FORM FOR OSD S 2016 SUMMER CAMP

ADULT VOLUNTEER FORM FOR OSD S 2016 SUMMER CAMP ADULT VOLUNTEER FORM FOR OSD S 2016 SUMMER CAMP Note: Complete these forms and send ASAP. Background and Fingerprint forms will be sent to you. Allow at least 6-7 weeks before May 5 th. I would like to

More information

Dear Applicant: Application Please complete and return the attached forms.

Dear Applicant: Application Please complete and return the attached forms. Dear Applicant: Thank you for your inquiry regarding a position in Sesser-Valier Community Unit School District No. 196. Listed below are the items necessary to complete the application process. Application

More information

COSMETOLOGY TEACHER REGISTRATION APPLICATION

COSMETOLOGY TEACHER REGISTRATION APPLICATION Oregon COSMETOLOGY TEACHER REGISTRATION APPLICATION Complete the following information and ATTACH copies of certificates or licenses that are legally required for employment in the field in which you teach

More information

VOLUNTEER APPLICATION

VOLUNTEER APPLICATION CASA of Los Angeles Member National Court Appointed Special Advocate Association 201 Centre Plaza Drive Suite 1100 Monterey Park, California 91754 Phone 323-859-2888 Fax 323-264-5020 www.casala.org VOLUNTEER

More information

Instructions for completion:

Instructions for completion: Application for Employment Instructions for completion: Human Resources Office One Angwin Avenue Angwin, CA 94508 707-965-6231 707-965-6400 (fax) hr@puc.edu (e-mail ) 1. Save this document before proceeding.

More information

Franchise Application

Franchise Application Franchise Application Youthland Academy 9352 Main Street Cincinnati, Ohio 45242 Office: 513-772-5888 Fax: 513-672-3387 www.youthlandacademy.com Confidential Personal Profile: Are you a US Citizen? yes

More information

INITIAL APPLICATION for CAREER AND TECHNICAL TRADE & INDUSTRIAL EDUCATION (CTTIE) TEACHING CERTIFICATE

INITIAL APPLICATION for CAREER AND TECHNICAL TRADE & INDUSTRIAL EDUCATION (CTTIE) TEACHING CERTIFICATE STATE OF LOUISIANA DEPARTMENT OF EDUCATION POST OFFICE BOX 94064, BATON ROUGE, LOUISIANA 70804-9064 Toll Free #: 1-877-453-2721 http://www.louisianaschools.net INITIAL APPLICATION for CAREER AND TECHNICAL

More information

NOTE: All mailings will be sent to the address you indicate below; if you change your address, you must advise this office.

NOTE: All mailings will be sent to the address you indicate below; if you change your address, you must advise this office. ATTACHMENT G 7/2013 STATE OF NEBRASKA Department of Health and Human Services Division of Public Health - Licensure Unit P.O. Box 94986 - Lincoln, Nebraska 68509-4986 Telephone #: 402-471-4918 Rita.watson@nebraska.gov

More information

APPLICATION FOR CERTIFIED NURSE AIDE BY EXAMINATION

APPLICATION FOR CERTIFIED NURSE AIDE BY EXAMINATION THE STATE of ALASKA Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing Nurse Aide Registry 550 West 7 th Avenue, Suite 1500 Anchorage,

More information

LICENSED PERSONNEL APPLICATION FORM (Administrator/Teacher/Counselor/Librarian/Nurse)

LICENSED PERSONNEL APPLICATION FORM (Administrator/Teacher/Counselor/Librarian/Nurse) MESA VISTA CONSOLIDATED SCHOOL DISTRICT P.O. BOX 309 OJO CALIENTE, NM 87549 LICENSED PERSONNEL APPLICATION FORM (Administrator/Teacher/Counselor/Librarian/Nurse) Name: Date of Application: Address: Phone

More information

Willow Springs R-IV Schools 215 West Fourth Street Willow Springs, MO 65793 417-469-3260

Willow Springs R-IV Schools 215 West Fourth Street Willow Springs, MO 65793 417-469-3260 Willow Springs R-IV Schools 215 West Fourth Street Willow Springs, MO 65793 417-469-3260 PERSONAL: Application for CERTIFICATED EMPLOYMENT (Please print or type) Last Name First Name Middle Name Social

More information

DENVER COMMUNITY SCHOOL DISTRICT Non-Certified Application for Employment

DENVER COMMUNITY SCHOOL DISTRICT Non-Certified Application for Employment DENVER COMMUNITY SCHOOL DISTRICT Non-Certified Application for Employment FULL NAME OTHER NAME(S) Current Address LAST FIRST MIDDLE INITIAL DATE PLEASE PROVIDE ANY OTHER NAMES YOU HAVE USED AT ANY TIME

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT 438 N. WHITE ROAD SAN JOSE, CA 95127 An Equal Opportunity Employer Thank you for your interest in employment with Momentum for Mental Health. In order for your application and

More information

ZANESVILLE CITY SCHOOLS 160 N. FOURTH ST. ZANESVILLE, OHIO 43701 P: (740) 454-9751

ZANESVILLE CITY SCHOOLS 160 N. FOURTH ST. ZANESVILLE, OHIO 43701 P: (740) 454-9751 ZANESVILLE CITY SCHOOLS 160 N. FOURTH ST. ZANESVILLE, OHIO 43701 P: (740) 454-9751 Submit all application materials to Human Resources Department at this address F: (740) 455-4325 The Zanesville City Schools

More information

Police Officer Application

Police Officer Application Town of Lowell Lowell Police Department 1333 East Commercial Avenue Lowell, Indiana, 46356 Police Officer Application TO: Instructions: All Lowell Police Officer Applicants (PLEASE READ CAREFULLY) Please

More information

Certification Update Packet

Certification Update Packet STATE OF LOUISIANA DEPARTMENT OF EDUCATION POST OFFICE BOX 94064, BATON ROUGE, LOUISIANA 70804-9064 Toll Free #: 1-877-453-2721 http://www.louisianaschools.net www.teachlouisiana.net Certification Update

More information

EMPLOYMENT APPLICATION PROFESSIONAL EDUCATOR

EMPLOYMENT APPLICATION PROFESSIONAL EDUCATOR EMPLOYMENT APPLICATION PROFESSIONAL EDUCATOR Mercer County Schools (304) 487-1551 Fax: (304) 425-3893 APPLICATION PROCESS We at Mercer County Schools appreciate your interest in our system and our students.

More information

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number:

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number: School Nurse Application for Employment TANQUE VERDE UNIFIED SCHOOL DISTRICT, NO. 13 11150 E. Tanque Verde Road Tucson, AZ 85749 520-749-5751 / fax 520-749-5400 All positions require an Arizona Registered

More information

KENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS PO BOX 1360 FRANKFORT KY 40602 502-564-3296 http://lpc.ky.gov

KENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS PO BOX 1360 FRANKFORT KY 40602 502-564-3296 http://lpc.ky.gov KENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS PO BOX 1360 FRANKFORT KY 40602 502-564-3296 http://lpc.ky.gov APPLICATION FOR LICENSED PROFESSIONAL COUNSELOR ASSOCIATE CHECKLIST FOR SUBMISSION $50.00

More information

HOMER COMMUNITY SCHOOLS 403 South Hillsdale Street Homer, MI 49245 Phone: 517-568-4463 Fax: 517-568-4468 Website: homerschools.net

HOMER COMMUNITY SCHOOLS 403 South Hillsdale Street Homer, MI 49245 Phone: 517-568-4463 Fax: 517-568-4468 Website: homerschools.net HOMER COMMUNITY SCHOOLS 403 South Hillsdale Street Homer, MI 49245 : 517-568-4463 Fax: 517-568-4468 Website: homerschools.net APPLICATION FOR EMPLOYMENT The Homer Community School District Board does not

More information

State of Utah Department of Commerce Division of Occupational and Professional Licensing

State of Utah Department of Commerce Division of Occupational and Professional Licensing State of Utah Department of Commerce Division of Occupational and Professional Licensing Official Use Only Number: Date Approved/Denied: Approved/Denied By: Psychologist APPLICANT INFORMATION Full Legal

More information

REQUEST FOR AN INITIAL OR RENEWAL OF A WORLD LANGUAGE PK-12/FLES CERTIFICATE

REQUEST FOR AN INITIAL OR RENEWAL OF A WORLD LANGUAGE PK-12/FLES CERTIFICATE STATE OF LOUISIANA POST OFFICE BOX 94064, BATON ROUGE, LOUISIANA 70804-9064 DEPARTMENT OF EDUCATION http://www.louisianabelieves.com Dear Prospective Louisiana Teacher: We are pleased that you are interested

More information

Last Name: First Name: M.I.: Date: Position Applied for Temporary Full Time Part Time Driver Helper Other. Did you graduate? YES. Did you graduate?

Last Name: First Name: M.I.: Date: Position Applied for Temporary Full Time Part Time Driver Helper Other. Did you graduate? YES. Did you graduate? APPLICANT INFORMATION Employment Application Last First M.I.: Date: Street Apartment/Unit #: City: State: ZIP: Phone: Cell Phone: Email Date Available: Desired Salary: Position Applied for Temporary Full

More information

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)

More information

LATX Operations US Highway 80 Waskom, TX APPLICATION FOR DRIVERS

LATX Operations US Highway 80 Waskom, TX APPLICATION FOR DRIVERS LATX Operations 13927 US Highway 80 Waskom, TX 75692 903-927-2091 APPLICATION FOR DRIVERS You Must answer every question. If any question does not apply to you, answer with Not Applicable (NA). In compliance

More information

Employment Application

Employment Application Employment Application West New York EMS is an Equal Opportunity Employer. All applicants are considered for positions without regard to race, creed, color, religion, sex, sexual orientation, national

More information

Belpre City School District 2014 Rockland Ave., Belpre, OH 45714 (740) 423-9511 FAX (740) 423-3050

Belpre City School District 2014 Rockland Ave., Belpre, OH 45714 (740) 423-9511 FAX (740) 423-3050 PROFESSIONAL EMPLOYMENT APPLICATION Belpre City School District 2014 Rockland Ave., Belpre, OH 45714 (740) 423-9511 FAX (740) 423-3050 Tony Dunn, Superintendent Missy Griffith, Treasurer NAME Last First

More information

CITY OF LITTLE CANADA APPLICATION FOR MASSAGE THERAPY ESTABLISHMENT LICENSE

CITY OF LITTLE CANADA APPLICATION FOR MASSAGE THERAPY ESTABLISHMENT LICENSE CITY OF LITTLE CANADA APPLICATION FOR MASSAGE THERAPY ESTABLISHMENT LICENSE Massage Therapy Principal Use License Fee $300 Massage Therapy Accessory Use License Fee $100 (Accessory or incidental use to

More information

Montana Application for Class 6 Specialist License School Psychologist Endorsement

Montana Application for Class 6 Specialist License School Psychologist Endorsement Montana Application for Class 6 Specialist License School Psychologist Endorsement Requirements for Montana Class 6 School Psychologist Specialist license 1. Verification of current credentials as a nationally

More information

DEPARTMENT OF HUMAN RESOURCES Post Office Box 1549 Suffolk, Virginia (757) Fax (757) Website:

DEPARTMENT OF HUMAN RESOURCES Post Office Box 1549 Suffolk, Virginia (757) Fax (757) Website: DEPARTMENT OF HUMAN RESOURCES Post Office Box 1549 Suffolk, Virginia 23439-1549 (757) 925-6758 Fax (757) 925-6751 Website: www.sps.k12.va.us THE APPLICATION PROCESS FOR PROFESSIONAL POSITIONS In order

More information

GENERAL. This information is provided pursuant to Public Law 93-579, the Privacy Act of December 31, 1974. PURPOSES AND USES

GENERAL. This information is provided pursuant to Public Law 93-579, the Privacy Act of December 31, 1974. PURPOSES AND USES BP-A0243 APPLICATION TO ENTER INSTITUTION AS REPRESENTATIVE CDFRM SEPT 10 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS GENERAL This information is provided pursuant to Public Law 93-579, the Privacy

More information

COLLATERAL CONSEQUENCES OF JUVENILE ADJUDICATIONS OF DELINQUENCY

COLLATERAL CONSEQUENCES OF JUVENILE ADJUDICATIONS OF DELINQUENCY COLLATERAL CONSEQUENCES OF JUVENILE ADJUDICATIONS OF DELINQUENCY This document is meant to provide general information about the collateral consequences of juvenile adjudications. This document is not

More information

BACKGROUND INFORMATION DISCLOSURE (BID)

BACKGROUND INFORMATION DISCLOSURE (BID) DEPARTMENT OF CHILDREN AND FAMILIES DCF-F-2978-E (R. 06/2016) BACKGROUND INFORMATION DISCLOSURE (BID) STATE OF WISCONSIN Wis. Stat. 48.685 Wis. Admin. Code DCF 12.03 Completion of this form is required

More information

EMPLOYMENT APPLICATION FORM

EMPLOYMENT APPLICATION FORM Elite Medical Transport, LLC - Deming 1100 S. Diamond Street - Deming PO Box 929 Santa Teresa, NM 88008 Main Telephone: (915) 542-1194~~Fax: 915-613-1693 EMPLOYMENT APPLICATION FORM Elite Medical Transport

More information

Employer Instructions for Use ODH Form 805 Uniform Employment Application for Nurse Aide Staff

Employer Instructions for Use ODH Form 805 Uniform Employment Application for Nurse Aide Staff Effective November 1, 2012 Employer Instructions for Use ODH Form 805 Uniform Employment Application for Nurse Aide Staff Purpose This form is to be used by employers as the only employment application

More information

PLEASE READ BEFORE COMPLETING APPLICATION

PLEASE READ BEFORE COMPLETING APPLICATION PLEASE READ BEFORE COMPLETING APPLICATION Information for Licensure: SOCIAL WORKER (LSW) Each item on the enclosed application must be completed. Allow 30 days for processing of the application. Failure

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT IMPORTANT: It is the policy of the Village of Plymouth to provide equal opportunity with regard to all terms and conditions of employment. The Village complies with federal and state laws prohibiting discrimination

More information

Camp Employment Application. Name Date of Application: Best Number to reach you: this is a home / work / cell number

Camp Employment Application. Name Date of Application: Best Number to reach you: this is a home / work / cell number FOR OFFICE USE ONLY Date App Rcd Ref #1 Rcd Ref #2 Rcd Ref #3 Rcd Interview Date Notes Camp Employment Application Please bring a current photo to your interview to be used for identification purposes.

More information

This form must be signed and returned with your application. Certification requirements can be found on page eleven of this application.

This form must be signed and returned with your application. Certification requirements can be found on page eleven of this application. This form must be signed and returned with your application. Certification requirements can be found on page eleven of this application. Name of Applicant: Application completed in its entirety Copy of

More information

Please follow these instructions when completing this application: 1. Please print legibly in ink.

Please follow these instructions when completing this application: 1. Please print legibly in ink. 525 Palisade Avenue Cliffside Park, NJ 0701 (201) 313-2064 Employment Application The Borough of Cliffside Park EMS Department is an Equal Opportunity Employer Operating under the New Jersey Department

More information

APPLICATION FOR EMPLOYMENT PLEASE PRINT PLAINLY

APPLICATION FOR EMPLOYMENT PLEASE PRINT PLAINLY 706 Railroad Street SE * Bemidji, Minnesota 56601 * Fax: 218.444.9521 NOTICE TO ALL APPLICANTS: Paul Bunyan Transit has a drug / alcohol testing policy that requires pre-employment testing of all newly

More information

APPLICATION FOR TEMPORARY 90-DAY CERTIFICATE

APPLICATION FOR TEMPORARY 90-DAY CERTIFICATE REV. 7/15 C.G.S. 10-145 C.G.S. 10-145d Regs. 10-145d-414 Connecticut State Department of Education Bureau of Educator Standards and Certification P.O. Box 150471 Room 243 Hartford, CT 06115-0471 www.ct.gov/sde/cert

More information

INSTRUCTION TO APPLICANTS FOR LICENSURE AS A OCCUPATIONAL THERAPIST OR OCCUPATIONAL THERAPY ASSISTANT

INSTRUCTION TO APPLICANTS FOR LICENSURE AS A OCCUPATIONAL THERAPIST OR OCCUPATIONAL THERAPY ASSISTANT INSTRUCTION TO APPLICANTS FOR LICENSURE AS A OCCUPATIONAL THERAPIST OR OCCUPATIONAL THERAPY ASSISTANT A. TEMPORARY LICENSE (90 DAYS)- Applicant must submit the following: Temporary licenses are valid for

More information

APPLICATION FORM. Be sure to notify your employer that you will be unable to practice while you wait for your license.

APPLICATION FORM. Be sure to notify your employer that you will be unable to practice while you wait for your license. Budget: ZZ117 Fund: 158 STATE BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY APPLICATION FORM Mail Code: MC2003 - - Phone: (512) 834-6627 - Fax: (512) 834-6677 E-mail: speech@dshs.state.tx.us

More information

APPLICANT INSTRUCTIONS

APPLICANT INSTRUCTIONS APPLICANT INSTRUCTIONS Thank you for your interest in employment with our Company. We appreciate your application, and look forward to the possibility of you joining our team. This sheet is for your information.

More information