APPLICATION FOR TEACHING POSITION

APPLICATION FOR TEACHING POSITION
Applicant Information
Name

First NameMiddle NameLast Name
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

City State ZipState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Social Security Number
Are you a US Citizen
If no explain status
Have you ever been convicted of a felony including any expunged sexual offenses
Position Desired:
Grades and/or subjects preferred
Date you could begin working

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How long should the application remain active?
Licensure and Skills
Do you hold a valid teaching certificate in this state?
If yes licensure number
Date of issue

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of expiration

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If you have no valid teaching, certificate has it been applied for?
List areas of certification
Additional job skills and training
For those seeking high school positions. Please identify any of the following in which you are able to direct or coach successfully.

Other
General Facts
Have you ever been terminated?
Have you ever had a nonrenewal on your contract?
If yes to either question above please explain.
Why do you wish to leave your present position?
Why do you wish to teach here.?

Education and professional Training.

Rows	School Attended (most recent first)	Dates Attended	Degree or Diploma	Major/Minor
1
2
3
4
5

Teaching Experience

Rows	Name and location of school or institution	Grades and subjects taught	Employment dates
1
2
3
4
5

Total years of experience in Elementary?
Total Years of experience in High School?
In which of the above was your observation and practice teaching done?

Give at least five references, including especially superintendents and principals under whom you have taught, who have first-hand knowledge of your character, personality, scholarship, and teaching ability.

Rows	Name of Reference	Address	Phone	Position
1
2
3
4
5

I hereby release the officers, agents, employees, and directors of each of my past employers from any and all liability arising from disclosure of personal records and from verbal appraisals of my past performance made to the superintendent and board members of the Harmony Grove School District. I understand and agree that this waiver includes any and all manners of action that I may not have or may have in the future concerning such disclosures, regardless of their nature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I certify that the information presented in this application is true. I understand that falsifying any information on this application is grounds for dismissal should I be employed by the Harmony Grove School District.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Veteran's Information
Are you a Veteran honorably discharged from a tour of active duty with the Armed Forces of the United States or served honorably in the National Guard Reserve Forces of the United States for a period of at least six (6) years?
If you answered yes to the above question, please attach all documentation applicable from the following list:
- Form DD-214 indicating honorable discharge
- A letter dated within the last six months from the applicant's command indicating years of service in the National Guard or Reserve forces as well as the applicant's current states
- Marriage license
- Death Certificate
- Disability letter from the Veteran's Administration (in the case of an applicant with a service-connected disability)
Note: If applicant indicates veteran status, but does not supply all necessary and appropriate documentation for the claimed status, the applicant will not be given veteran's preference. The burden is on the applicant to claim veteran's status and supply all appropriate documentation.
Please upload copies of college transcripts, NTE or Praxis Scores, and Teaching certificate.

Cancelof
Should be Empty:

Applicant Information

Licensure and Skills

General Facts

Veteran's Information