APPLICATION FOR PROFESSIONAL EMPLOYMENT

(Please print or type)

NAME__________________________________________________________________ SOCIAL SECURITY NO.___________________

Last First Middle Initial

PRESENT ADDRESS______________________________________________________ TELEPHONE ( ) .

Street or Box City State Zip Code Area Code Number

TYPE OF POSITION SOUGHT – Respond fully and specifically as possible.

Position(s) for which you are applying, in order of preference ________________________________________________________________

________________________________________________________________________________________________________________

Grades or subjects you are qualified to teach in order of preference ___________________________________________________________

________________________________________________________________________________________________________________

Describe in a brief paragraph the personal qualities you possess that particularly qualify you for the position(s) in which you are applying:

________________________________________________________________________________________________________________

PROFESSIONAL CERTIFICATE OR LICENSE – Professional applicants must hold or be qualified for valid Arkansas certification or licensure appropriate to the position for which they are employed.

Arkansas certificate or license: Type_____________________________________ Expiration Date________________________________

Grade, subject, position_____________________________________________Endorsements____________________________________

Out-of-state certificate or license: State_______________________________________Type_____________________________________

Expiration Date__________________________________ Grade, subject, or position endorsements________________________________

EDUCATION AND PROFESSIONAL TRAINING – Official transcripts reflecting all post-secondary preparation to date must be received before your application may be placed in active status. Use additional sheets if required.

Name & Location of High Schools, Training Schools, Colleges and Universities Attended	Dates of Attendance From To . Month Year Month Year .	Specialization	Diploma, Degree, or Semester Hrs. Kind Date Received Or Expected

Have you ever completed a student teaching, practicum, or other field training experience? _________ If yes, complete the block below.

Sponsoring Institution	Institutional Supervisor	Training Assignments	Location of Assignments (s)	On-Site Supervisor(s)

EMPLOYMENT HISTORY – List all employment to date. Specify part-time employment. Use additional sheets if required.

Employer	Location	Principal or Supervisor	Position	From To Month Year Month Year	Reason for Leaving

ADDITIONAL INFORMATION – Identify all additional experiences and activities in the past three years which have strengthened your background for the position (s) in which you are applying.

Volunteer work with young people, e.g., scouting, tutoring, summer camp, etc.___________________________________________________

________________________________________________________________________________________________________________

Professional memberships and offices held______________________________________________________________________________

________________________________________________________________________________________________________________

Special professional assignments, e.g., curriculum work, team leaders, department head, etc.______________________________________

________________________________________________________________________________________________________________

Particular skills, talents, abilities, or interests_____________________________________________________________________________

Special honors, awards, or recognitions_________________________________________________________________________________

Do you speak a foreign language?_______ If yes, Identify language__________________________________________________________

Student activities you feel qualified to direct_____________________________________________________________________________

________________________________________________________________________________________________________________

NOTE TO APPLICANT:	Thank you for completing this application. The information which you have provided will be held confidential. Your application and personal references will be reviewed carefully. As appropriate vacancies occur, we shall schedule personal interviews as necessary. Your application folder will remain active for one year, unless you instruct us otherwise. You may update the information in the application folder at any time. Central School District No. 1 is an equal opportunity/affirmative action employer and no person on the basis of race, color, national origin, age, six, handicap or any other category covered by law, be denied employment.

APPLICANT’S STATEMENT:	Your application will not be processed unless you sign and date the statement below.


	I hereby certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal . You are hereby authorized to make any pertinent investigation of my background.


	SIGNATURE______________________________________ DATE___________________________

APPLICATION FOR PROFESSIONAL EMPLOYMENT

Dates of Attendance

Institutional

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