CERTIFIED TEACHER APPLICATION INSTRUCTIONS

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1 School City of Whiting 1500 Center Street, Whiting, IN Phone: Fax: CERTIFIED TEACHER APPLICATION INSTRUCTIONS The completed employment application can not be evaluated unless all of the following materials have been provided: 1. Application form fully completed and signed 2. Current resume 3. Copy of Indiana Teacher Certificate, Out-Of-State Teacher Certificate or a letter from your college/university showing you have completed the requirements for a degree 4. Copy of transcripts 5. Skills Questionnaire fully completed 6. If yes was answered to any of the questions in the background section, please attach sheet explaining circumstances 7. Expanded Criminal History Request form completed and signed.** ** NOTE: Only applicants recommended for employment with the School City of Whiting are required to complete an expanded criminal background check. Once a candidate is selected, a $28.00 cashier s check or money order payable to the School City of Whiting will be required for an outside vendor to conduct the applicant s Expanded Criminal History Check. The position is contingent upon the completion of a satisfactory criminal background investigation. (see page 2 for district s policy) **NOTE: If you do not have a current IN Teacher License, you will need to apply for one online. The link is There is a fee for the license** Please return the completed application packet to: School City of Whiting Human Resources Department 1500 Center Street Whiting, IN Phone: Fax:

2 School City of Whiting Expanded Criminal History Checks Effective July 1, 2009, the State of Indiana requires all school corporations, to obtain an expanded criminal history check on all new employees. The definition of expanded criminal history check is found at IC , which is included below: Sec "Expanded criminal history check" means a criminal history background check of an individual that includes: (1) a: (A) search of the records maintained by all counties in Indiana in which the individual who is the subject of the background check resided; (B) search of the records maintained by all counties or similar governmental units in another state, if the individual who is the subject of the background check resided in another state; and (C) check of: (i) sex offender registries in all fifty (50) states; or (ii) the national sex offender registry maintained by the United States Department of Justice; OR (2) a: (A) national criminal history background check (as defined in IC ); and (B) check of: (i) sex offender registries in all fifty (50) states; or (ii) the national sex offender registry maintained by the United States Department of Justice. To help ensure a safe environment and as required by state law, the School City of Whiting will obtain for each individual hired for employment an expanded criminal history check. The School City of Whiting has contracted with an outside vendor to conduct the expanded criminal history checks. The cost of the expanded criminal history check will be the responsibility of the applicant. The candidate will fill out the release and background information form and submit payment to the district by cashier s check or money order, payable to the School City of Whiting. This must be done prior to the individual s employment and no later than three (3) months after the individual s employment begins. Failure to answer honestly any questions related to the expanded criminal history check may be cause for immediate termination of the applicant s employment. **ALL employment with the School City of Whiting is contingent upon the completion of a satisfactory criminal background investigation. Conviction or other disposition of a crime is not necessarily an automatic bar to employment. The school district will evaluate each case individually. ** 2

3 School City of Whiting 1500 Center Street, Whiting, IN Phone: Fax: CERTIFIED STAFF APPLICATION FOR EMPLOYMENT School City of Whiting does not discriminate on the basis of race, color, sex, age, disability, religion or national origin. This form must be filled out completely. All information will be treated in a confidential manner. Your application will be kept on file for a period of one year from the date received. BACKGROUND INFORMATION (Please print or type) Date of Application: NAME: TELEPHONE: HOME ADDRESS: CITY: STATE: ZIP: SOCIAL SECURITY NUMBER: - - MILITARY SERVICE: YES NO IF YES, DATE OF ENTRY: DATE OF DISCHARGE: POSITION DESIRED: EARLY CHILDHOOD (PRE-K TO K) ELEMENTARY (1-5) JUNIOR HIGH (6-8) SPECIALIZATION: HIGH SCHOOL (9-12) SPECIALIZATION: OTHER (explain) CERTIFICATION: Indiana State law requires all public school teaches to hold a valid teaching certificate or show proof of obtaining an Indiana license. Do you have an Indiana teaching certificate? YES NO If YES, certificate number: Date of issue: Expiration date: Areas of specialization: If NO, and you are new to the profession or from out-of-state, have you started the process of applying for your Indiana certificate? YES NO Area of specialization: *YOU MUST ATTACH A COPY OF YOUR INDIANA TEACHING CERTIFICATE WITH YOUR APPLICATION* 3

4 EDUCATION: High School, College and/or Graduate School, starting with most recent. Attach copy of transcripts Name of Institution and Location Dates: To/From Major (s) Graduate Diploma/Degree STUDENT TEACHING EXPERIENCE: (For applicants with less than 3 years teaching experience) School System Principal Supervising Teacher Grades/Subject Dates PROFESSIONAL HONORS, DISTINCTIONS OR AWARDS: EXTRA CURRICULAR ACTIVITIES: Please list any activities that you can/would like to direct, supervise or coach:

5 TEACHING EXPERIENCE: Do NOT list student teaching or substitute teaching experience. Show only creditable years for which service records are available up to and including teaching experience in the last 5 years, with the most recent first. Please use additional sheets if needed. Year Name of School and Address Position Grade/Subject Principal Reason for Leaving REFERENCES: Do not list relatives. List former employers, co-workers or others who can best describe your qualifications for this position. Give full name and address of each reference. In naming references, if you have had teaching experience, list supervisors, principals, and all superintendents who are familiar with your classroom work. If you have no teaching experience, give the names of the college instructors with whom you have your major subjects. You must include the name of the instructor who supervised your practice teaching course. NAME MAILING ADDRESS PHONE POSITION 5

6 BACKGROUND QUESTIONS: 1.Have you ever been disciplined, discharged, refused employment or asked to resign from a prior position? YES NO 2. Have you ever resigned from a position after being offered the opportunity to resign YES NO rather than be terminated? 4. Have you ever been charged, investigated for sexual abuse or harassment of another YES NO person or other offense relating to children? 5. Have you ever been arrested, convicted or received probation for a crime/offense in the State of Indiana or any other state? YES NO 6. Have you ever entered a plea of guilty or no contest to any crime the State of Indiana or any other state? (other than a minor traffic offense.) YES NO 7. Are you currently awaiting trial for a crime/offense you have been charged with? YES NO 8. Have you ever had a teaching certificate suspended or revoked in this state or any other state? YES NO NOTE: ** If you have answered YES to any of the previous questions, please provide full details on an additional sheet. Conviction or other disposition of a crime is not necessarily an automatic bar to employment. The school district will evaluate each case individually. ** APPLICANTS CERTIFICATION AND AGREEMENT READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION FOR EMPLOYMENT Authorization and Release I authorize the School City of Whiting to investigate and check my employment and criminal history, including without limitation, reference checks, and to seek the release of investigatory information, including my criminal history, possessed by any private or public employer or any local, state, or federal agency. I authorize these private or public employers or local, state, or federal agencies to release and to provide to the School City of Whiting any information they may possess concerning my employment or criminal history. This authorization for the release of information includes both records regardless of how stored or maintained and information by interview. I will cooperate to the extent necessary to obtain the release of this information. I expressly waive and fully release the School City of Whiting, its agents, employees, attorneys, and/or board of school trustees from any and all claims or causes of action arising in connection with any request for or provision of such information, including without limitation, defamation, infliction of emotional distress, invasion of privacy or interference with contractual relations that I might otherwise have against the School City of Whiting, its agents, employees, attorneys, and/or board of school trustees, or against any individual, corporate, and/or agency provider of such information. I have read this Authorization and Release, and I expressly agree to the terms set out herein. I also agree that a copy of this Authorization and Release, whether it be a photocopy, or otherwise, shall have equal standing and import as if it were an original. Signature Date I understand and agree that any false or misleading information on this application shall be sufficient grounds to refuse employment, and/or to cause termination of employment and contract. 6

7 Signature Date School City of Whiting 1500 Center Street Whiting, IN WRITTEN COMMUNICATIONS SKILLS QUESTIONNAIRE for Certified Applicants Name Date DIRECTIONS: Please provide a handwritten response for each question below. If you have a disability which affects your ability to complete this questionnaire, let us know so that other arrangements can be made. If additional space is needed, please use additional sheets. 1. From your perspective, describe the characteristics of an effective classroom teacher. 2. What do you perceive to be your special skills and abilities as a classroom teacher? 3. What contribution(s) do you hope to make as part of the teaching profession and as a teacher in Whiting School District? 7

8 4. What kind of things do you plan to do on a continuing basis to improve your skills, abilities and overall effectiveness as a classroom teacher? SCHOOL CITY OF WHITING 8

9 NOTICE REGARDING BACKGROUND INVESTIGATION A consumer report (background screening report) and/or an investigative consumer report which may include information concerning your character, employment history, general reputation, personal characteristics, police record, education, qualifications, motor vehicle record, mode of living, and/or credit and indebtedness may be obtained in connection with your application for and/or continued employment with SCHOOL CITY OF WHITING. A consumer report and/or an investigative consumer report may be obtained at any time during the application process or during your employment with the SCHOOL CITY OF WHITING. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by Safe Hiring Solutions LLC, P.O. Box 295, Danville, IN AUTHORIZATION By signing below, I,, hereby voluntarily authorize SCHOOL CITY OF WHITING to obtain either a consumer or an investigative consumer report about me from a consumer reporting agency and to consider this information when making decisions regarding my employment and/or continued employment at SCHOOL CITY OF WHITING. I understand that I have rights under the Fair Credit Reporting Act, including rights discussed above. This report may be delivered in either written or electronic form. Print Name (last, first, middle) Social Security Number Date of Birth (MM/DD/YYYY) Drivers License Number Drivers License State (For ID Purposes Only) Any other names I have been known by: Current Address: Previous Addresses (Last 7 Years) Signature Date Check for CA, MN or OK applicants only, if you would like to receive a copy of the consumer report if one is obtained. 9

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