Application for Teaching Positions

Transcription

Application for Teaching Positions
TEACHER APPLICATION
LAKE COUNTY SCHOOLS
819 McBride Street
Tiptonville, TN 38079
NAME: _____________________________________________________________________________________
(First)
(Middle/Maiden)
(Last)
Date: _______________________Social Security #: _________________________DOB: ____________________
Please attach a recent picture to this application.
PERSONAL DATA:
Present Address: ______________________________________________________________________
(Street)
(City)
______________________________________________________________________
(State)
(Zip Code)
Email address if available: _______________________________________________________________
Telephone: ___________________________________________________________________________
(Home)
(Cell)
(Business)
Permanent Address:____________________________________________________________________
(Street)
(City)
_______________________________________________________________________
(State)
(Zip Code)
Have you ever been convicted of a felony? ____________________ if yes, please explain: ________________
___________________________________________________________________________________________
POSITION FOR WHICH APPLICATION IS MADE:
Elementary: _________________________________________________ (specific grade or grade span)
Middle School: ______________________________________________ (specific grade and/or subjects)
High School: ________________________________________________ (specific grade and/or subjects)
Vocational: _________________________________________________ (specific grade and/or subjects)
Other position: _______________________________________________
Note: Applicants for coaching positions should include a summary of their athletic experience.
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CERTIFICATION:
Type(s) of Tennessee Teacher’s Certificate(s)
Held: _________________________________________________________________________
Expected: _____________________________________________________________________
Certification Number(s): ________________________________________________________________
Date of Expiration: _____________________________________________________________________
Grade Level(s): ________________________________________________________________________
Area(s) of Endorsement: ________________________________________________________________
________________________________________________________________
Career Ladder Level: ___________________________________________________________________
Have you acquired tenure In Tennessee? _________________________________________________________
If yes, in what school district? ____________________________________________________________
Date you would be available for employment: _____________________________________________________
EDUCATIONAL PREPARATION:
Earned degree(s): ______________________________________________________________________
GPA based on a 4.00 scale _______________________________________________________________
If you are applying for a middle school or high school position, what is your GPA in your area of
endorsement (based on a 4.00 scale): ____________________________________________________________
SCHOOLS ATTENDED:
School, College or
Address
Dates Attended
Major
University
Student
Grade Level(s)
Teaching/Practicums
Taught
Subject(s) Taught
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School System
Degree or
Date of
Diploma
Graduation
University
Cooperating
Supervisor
Teacher(s)
TEACHING EXPERIENCE: Please list in order beginning with the most recent. If you have not been previously
employed as a teacher, please check here ______ and go to the next section.
Position
Name of District
City and State
Specific Years Employed
OTHER RELEVANT EMPLOYMENT OR EXPERIENCE:
Position
Employer
City and State
Specific Years Employed
NUMBER OF COLLEGE HOURS EARNED IN READING:
_______________
NUMBER OF COLLEGE HOURS EARNED IN MATHEMATICS: ______________
BACKGROUND INFORMATION: If you answer “yes” to any of the following questions, please attach a written
response describing, in detail, an explanation of the circumstances involved.
1. Have you ever been convicted of a violation of law other than a minor traffic violation: The term
“conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a
suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilt by a jury or judge.
_____yes
_____no
2. Have you ever been terminated or discharged or resigned at the request of your employer from any
job related to preK-12 education?
_____yes
_____no
3. In connection with your professional responsibilities, have you ever been the subject of a complaint or
been disciplined by a court or a licensing board of any state?
_____yes
_____no
4. Are you currently under investigation by any regulatory body for any alleged misconduct or other
alleged grounds for discipline?
_____yes
_____no
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REFERENCES (Professional Only) The applicant is responsible for contacting those persons listed below to have
them complete and send to this office the form “Confidential Teacher Appraisal”
Name
Complete Address
Occupation
Phone number
1.
2.
3.
4.
ADDITIONAL INFORMATION:
1. Have an official copy of your transcript(s) forwarded from the college or university to this office.
2. Request your college Placement Office (if your college offers this service) to forward your credentials
to this office.
3. Documents filed in support of this application will not be returned.
4. This application, along with supportive documents, should be returned to:
Lake County Board of Education
819 McBride Street
Tiptonville, TN 38079
CHAPTER 178, THE PUBLIC ACTS OF 1973, TENNESSEE CODE ANNOTATED, SECTION 49-5-406 requires the
following:
(Please mark either HAVE or HAVE NOT for each choice below)
I further certify that I (HAVE or HAVE NOT) been convicted of a misdemeanor or felony in any state of the
United States. If HAVE is indicated, explain fully the details of each such conviction on a separate sheet of
paper.
I further certify that I (HAVE or HAVE NOT) been dismissed from any previous employment for improper or
unprofessional conduct, inefficient service, neglect of duty, incompetence, or insubordination as the same
are defined in Section 49-5-501 of the Tennessee Code. If HAVE is indicated, explain fully the details of each
such dismissal on a separate sheet of paper. The employer’s non-renewal of a yearly contract need not be
indicated unless the non-renewal was for cause as listed above.
If my most recent employer were another Tennessee public school system and if my termination were
voluntary, I hereby certify that my resignation was, or will be, submitted at least 30 days prior to the
beginning date stated hereon; or, if within 30 days, that the previous board has waived its right to such
notice. A copy of my letter of resignation or of the said board action is attached or will be provided.
I understand that misrepresentation of any of these certifications may subject me to the penalties prescribed
in Section 49-5-406 of the Tennessee Code.
I, the undersigned, hereby certify that the foregoing information is true and correct. I fully understand that
falsification of this application will be cause for rejection of the application and/or discharge. Further, I hereby
agree to release all investigative records to the Lake County Board of Education for examination for the
purposes of verifying the accuracy of criminal information and to supply a fingerprint sample and submit t a
criminal history records check to be conducted by the Tennessee Bureau of Investigation.
I certify that all applicable questions on this application have been completed and that the information
provided is accurate. I understand that withholding information or providing inaccurate information may be
grounds for invalidating a contract.
Full Name (printed) _____________________________________ Signature ____________________________
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Address_______________________________________ City _____________________ State ____Zip_________
Phone number (___) ____-_______
Date: ________________________________________
The Lake County Board of Education is an Equal Opportunity employer. This district does not discriminate based on
gender, race, national origin, religion, creed, age, marital status, sexual orientation, or disability.
Briefly write a statement of your teaching philosophy below:
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