Teacher Application Form

Teacher Application
Where Great Teachers Meet Great Opportunities
Position for which you are applying
Personal Information
Full Name
First NameMiddle NameLast Name
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
High School Name
Years Attended
Graduated?
YesNo
Degree / Major
College Name
Years Attended
Graduated?
YesNo
Degree / Major
Trade or Correspondence School
Years Attended
Graduated?
YesNo
Degree / Major
Teaching Experience
Please include dates employed, Employer name, address and phone number, Position, Salary, Wage, Supervisor's name and phone number, and your reason for leaving.
Most recent position
Second most recent position
Third most recent position
Fourth most recent position
Please explain any gaps in employment
Other Relevant Experience
Please list any other experience you have, including dates, employer name address and phone number, position, salary, supervisor's name and phone number, and reason for leaving.
Experience #1
Experience #2
Experience #3
Please list four individuals who are very familiar with your professional work and character who may be contacted. Please include their name, position, business phone, home or cell phone, and address.
References
In the field below, please respond to each of the following questions:
1. Why do you want to be a teacher for the Community Schools?
2. What experience do you have specific to the position you are applying for and how would you use that experience to be a success in the Oelwein Commuunity Schools?
3. Describe your greatest accomplishments as an educator.
Narrative Response
List degrees, honors, commendations, elective or appointive offices held, or other distinctions received.
HONORS AND DISTINCTIONS
BACKGROUND INFORMATION
Are you, or have you ever been, listed on a sex offender registry?
YesNo
Are you, or have you ever been, listed on a child or dependant adult abuse registry?
YesNo
Have you ever been found guilty, accepted a guilty, or entered a plea of no-contest for any criminal charge?
YesNo
Have you ever received a deferred judgment, or in some other way had a guilty plea or conviction removed from your record?
YesNo
Have you ever received a deferred judgment, or in some other way had a guilty plea or conviction removed from your record?
YesNo
If you answered “yes” to any of the above questions, provide date, incident, specific charge, city/state in which occurred:
Have you ever been asked to resign from a position, or been given the choice of resigning or being terminated from your position?
YesNo
Have you ever been the subject of an investigation or other formal/informal proceeding that resulted in the termination of your employment or resignation?
YesNo
Have you ever been the subject of an investigation into wrong doing or other formal/informal proceeding, resulting in disciplinary or criminal action?
YesNo
Briefly explain any “yes” response(s):
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 or infraction and the position for which you are applying will be considered.
Are you legally eligible to work in the United States?
YesNo
Are you able to perform with or without reasonable accommodation, the essential job functions required of the position?
YesNo
Do you wish to be considered for veteran’s preference?
YesNo
IF YES, PLEASE FILL OUT NEXT SECTION
Military Duty
Active Duty
(mm / yy)
To
(mm / yy)
Branch
Location of Duty
Rank at Discharge
Type of Discharge
Reserve Duty
(mm / yy)
To
(mm / yy)
Branch
Obligation
Times of Current Training Day
AGREEMENT (Read carefully before signing or submitting electronically)
By my signature:
• I acknowledge that individuals who provide false, inaccurate, or incomplete information in the application form, in an interview, or any other part of the hiring process or who fail to disclose information requested in the application form, in an interview, or any other part of the hiring process will not be eligible for employment, or, if they are hired, they will be subject to termination.
• I acknowledge that to the fullest extent permitted by state and federal law, the District will consider all information concerning an applicant or an employee in making hiring, termination, and other employment-related decisions. The term "all information" includes information of any kind (verbal, written, photographic, videographic, etc.) that is accessible in any medium (print, electronic, etc.) from any source.
• I acknowledge that the District will consider public information and other information to which it has lawful access. This may include information that is contained in social networking sites, blogs, and other electronic sites, such as YouTube. If there is information that pertains to me that I believe requires explanation, interpretation, or clarification when it is considered by the District, it is my obligation to communicate this information to the District.
• I authorize the District to conduct a complete check regarding my background including, but not limited to, criminal record, child and dependent adult abuse registry screening, and sex offender registry. I agree to prepare and sign any other form necessary to complete a criminal background check. I further authorize all government agencies departments, bureaus, or related entities to release any and all information regarding my criminal history, if any. I agree to immediately notify the District if I should be convicted of any crime while my application is pending, or during my period of employment if hired.
• I authorize all current and former employers, teachers, and references to release all information regarding my professional competence, performance, character, and background. I waive any right I may have against any person contacted as a reference concerning this application.
• I acknowledge that information that is relevant to the District’s decisions will be considered regardless of the date on which the District obtains the information and regardless of the date on which the information was first published, created, or made accessible to the District.
• I understand that this application will be considered active for twelve (12) months from the date filed. I further understand that if I am employed by the Community Schools, this application and associated documents will become part of my permanent record.
• I understand that this application is not a contract of employment. In accepting the position, if hired, I understand that employment is at will unless otherwise specified by the Code of Iowa. I acknowledge that the District may discharge an at-will employee at any time for any legal reason or no reason at all.
• I agree to submit to both pre-employment and post-employment random drug and alcohol testing. (Note: This only applies to Bus Drivers as required by the State.)
Do you currently hold a valid Teachers License with appropriate endorsement for the position you are applying for?
YesNo
Please list your endorsements:
Are you currently under contract for any school district next year?
YesNo
By my electronic submission of this form:
• I attest that all the information contained in this application is accurate, complete, and true.
• I am bound by all elements of the agreement section of the application.
• I understand and accept that electronic submission will be considered equivalent to an original hand written signature on a paper copy of the application.
Name
First NameLast Name
Date
MonthDayYear
Date
Signature
Clear
1. All application materials should be returned to:
Mr. John Doe, Supt.
Community Schools
111 Eighth Ave. SE
Oelwein, IA 11111
2. Applicants, and/or their designees, are asked not to contact members of the Board of Directors during this search process.
3. Screening for this position will continue until the position is filled.
4. In order to be considered for this position, your application materials must include the following (please do not staple or bind your application materials):
a. A letter of application
b. Completed application form (including signatures)
c. Resume
d. Four recent letters of recommendation regarding your professional work (credentials will
suffice if the information is current)
e. A copy of (or documented evidence of eligibilty) a current teachers license and endorsements
f. Photocopy of college/university transcripts
5. For further information contact:
Mrs. Jane Doe
Secretary
Central Office Building
222 Eighth Ave. SE
Oelwein, IA 11111
Phone: 123-456-7890
Email: example@example.com
The Community School District will select for employment qualified applicants for each position without improper discrimination on the basis of race, color, creed, religion, sex, sexual orientation, gender identity, national origin, ethnic background, age, or disability. Persons with disabilities who can perform the essential functions of an assignment with or without reasonable accommodation shall be considered qualified applicants. The District shall take affirmative action in the recruitment, appointment, assignment and advancement of personnel to accomplish the goals of equal employment opportunity. In keeping with the law, the District shall consider the veteran status of applicants.
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Teacher Application

Personal Information