EMPLOYMENT APPLICATION CERTIFIED TEACHER

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1 EMPLOYMENT APPLICATION CERTIFIED TEACHER A. APPLICANT INFORMATION (please print) Full name: Last First Middle Address: Street City, state ZIP code Phone: ( ) ( ) Home Cell B. POSITION DESIRED Position Date available I prefer to work (check all that apply): Full-time Part-time Either Substitute C. LICENSURE Priority Grade Preference Subject Preference (if applicable) 1 st 2 nd 3 rd Ohio license held (please attach a copy of your license to the application): Type Endorsement Level Dates Out-of-state certification: State Endorsement Level Dates D. EDUCATIONAL QUALIFICATIONS Please attach photocopies of your college transcripts. Should you be offered a position, official copies of your college transcripts will be required for inclusion in your personnel file. Issuing Institution/Address Degree Major/Minor Year Received

2 E. CURRENT TEACHING EXPERIENCE Current position: Grade level(s): School: Address: Employment dates: Supervisor s/principal s name: Phone number: ( ) Current annual salary: $ mos. F. PREVIOUS TEACHING EXPERIENCE School/Address Grades/Subjects Taught Principal/Telephone Years From/To List any other educational advantages you have had, including opportunities for travel: List any conferences or seminars you have led or attended in the past: G. NON-TEACHING EXPERIENCE (most recent first) Company/Address Position/Duties Supervisor/Telephone Years From/To

3 H. GENERAL INFORMATION 1. Are you physically and mentally able to perform the essential functions of the position for which you are applying? Yes No If no, please describe: 2. First aid: Are you trained in first aid? No Yes (date completed: ) CPR: Are you CPR certified? No Yes (date completed: ) 3. Foreign language ability: Speak: Fluently Some None Read/write: Fluently Some None 4. Please list computer software and office machines with which you have experience: 5. Have you already signed a contract for next year with any other institution? Yes No I. PERSONAL HISTORY 1. Are you a United States citizen? Yes No 2. Are you prevented from lawfully becoming employed in the United States because of Visa or Yes No immigration status (for compliance with the Immigration Reform and Control Act)? 3. Have you ever been asked to resign from a position? Yes No 4. Have you ever resigned rather than face disciplinary action and/or non-renewal by an employer Yes No and/or revocation of a license/certificate? 5. Have you ever been convicted of, pled no contest to, or received a deferred sentence for: a) any Yes No crime, and/or b) any crime involving unlawful sexual behavior or unlawful behavior involving children? 6. Have you ever been dismissed by, or resigned from, a school district or other employer as a result Yes No of an allegation of unlawful behavior involving a child, including unlawful sexual behavior? 7. Have you ever had a credential, certificate, or license to teach denied, annulled, revoked, or Yes No suspended? 8. Have you ever been convicted of a felony or misdemeanor (other than minor traffic offenses)? Yes No 9. Have you ever worked under any other name? Yes No If yes, please list name(s): If you answered yes to any of the questions in Section I, numbers 2 through 8, please provide complete details on a separate sheet, stating the date, charge, place, and action taken, if applicable.

4 J. ACTIVITIES/SPORTS Activities you are qualified by preparation to instruct: Vocal music Drama Bilingual education Instrumental music Journalism ESL Speech/forensics Yearbook Reading/Literacy Gifted & Talented Alternative education Other Sports you are qualified by preparation to coach: Football Basketball Cross country Baseball Track Soccer Golf Gymnastics Other Weight training Volleyball Cheerleading Wrestling K. REFERENCES Include individuals who are familiar with your professional potential. Do not include family members/relatives. Include any administrator with whom you have worked or college instructor if you have not yet graduated. References will be contacted should you be a candidate for a specific position. Name/School/Company Title Address/Telephone EMPLOYMENT VERIFICATION AND CRIMINAL RECORDS CHECK It is understood and agreed that the West Muskingum School District Board of Education may contact my former employer(s) for verification of my employment history and the Bureau of Criminal Identification and Investigation (BCII) and Federal Bureau of Investigation (FBI) for a background check (which includes fingerprinting) and I hereby consent to such inquiries. I understand that I am responsible for any cost involved in obtaining the BCI and FBI check. I certify that all information on this application is true and complete to the best of my knowledge, and I understand that any withholding or falsification of information on this application is grounds for dismissal. NOTE: Applicants are also responsible for obtaining a TB test (current within 90 days) at their own expense prior to employment. Applicant s Signature Date It is the policy of the West Muskingum Board of Education that the best-qualified applicant shall be selected for each position without regard to race, color, religion, national origin, age, sex, or marital status.

5 TEACHER APPLICANT QUESTIONS The following questions are a very important part of our screening process. Please reflect upon them carefully and give us your candid responses. Please limit your responses to the space provided; do not exceed. 1. What are your three most important reasons for wanting to be a teacher? 2. How much do you want to know about your students in order to be most helpful to them? 3. What three things do you most want to know about your students? 4. What do you need to know in order to begin your lesson planning for a class? 5. What four key components do you believe you must include in your plan? 4) 6. When you think about your students, in what major ways do you most want to influence their lives? 7. What two core teaching strategies do you most use to achieve this result? Applicant s signature Date Please send application to superintendent via USPS Ventures for Excellence, Inc.

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