Catoosa Public Schools - Certified Employee Application

Test

Date:

Name

Address

City

State

Zip

Email Address

Certification #

Certification Expiration Date:

Home Phone Number

Work Phone Number

Position Applied For

Early Childhood K-2

Elementary Grades 1-3

Elementary Grades 4-5

High School Grades 9-12

Subject(s)

Junior High Grades 6-8

Subject(s)

Administrator(Elementary)

Administrator(Secondary)

Counselor

Library-Media

Special Education

Other

EVIDENCE OF PROFESSIONAL AND EDUCATIONAL LEADERSHIP

Professional Organizations

What Professional Journals have you read during the past year?

What Professional journals do you consider most helpful in your teaching field?

What Professional conferences or education association meetings have you attended in the last two school years?

AREAS OF CERTIFICATION (CHECK APPROPRIATE LINES)

1000 Elementary

1000 Early Childhood

1501 Elem. Education

2500 Special Education

2501 Emotionally Disturbed

2503 Hearing Impaired

2505 Learning Disability

2507 Mentally Handicap

Physically Handicap

2511 Visually Impaired

Secondary Education

3000 Agriculture

3001 Agriculture General

4500 Home Economics

4501 Home Economics/Gen.

4503 Adult/Family Living

4505 Career Education

4507 Child Dev./Parent Ed.

4509 Consumer Education

4511 Nutrition Education

4513 Textiles/Clothing

5000 Industrial Arts

5001 Drafting Technology

5003 Electric/Electronics

5005 Gen. Industrial Arts

5007 Graphics

5009 Metal Technology

5011 Power Technology

5013 Wood Technology

5500 Mathematics

5501 Algebra

5503 Analysis

5505 Calculus

5507 Computer Sci/App.

5509 General Mathematics

5511 Geometry

5513 Linear algebra

5517 Trigonometry

5575 Math Jr. High

7000 Specialized Services

7001 Occupational Therapy

7003 Physical Therapy

7005 School Nurse

7500 Industrial Arts

7501 DE/Marketing

7503 Occup. Agriculture

7505 Occup. Home Economics

7507 Technical Education

7509 Trade/Indus. Education

7511 Voc. Agriculture

7513 Voc. Business/Office

7515 Voc. Health Occup.

7517 Voc. Home Economics

8000 Special Endorsements

8001 Aeronautics

8003 Athletic Coaching

8005 Bilingual/Multicultural

8007 Computer Science

8009 Driver/Safety Ed.

8011 English Second Language

8013 Psychology

8015 ROTC

Type

1. Major

2. Minor

3. Cert. End.

4. Conv. End.

5. Spec. End.

Level

90 N-K

91 N-2

92 N-12

93 K-8

94 K-12

95 7-8 Endors.

96 7-12

9709-12

99 All

065 Class

P Professional

S Standard

A Prov. 1

B. Prov. II

C Prov. I-Voc.

D Prov. II-Voc.

E Emergency

L License

Degree

Doctorate

Ed. Specialist

Masters

Bachelors

Associate

Other

References: List the name of four references capable of giving information about your teaching and preparation for teaching. List at least one administrator for each of your teaching positions.

Full Name of Reference

Position

School Name and Address

Phone

Full Name of Reference

Position

School Name and Address

Phone

Full Name of Reference

Position

School Name and Address

Phone

Full Name of Reference

Position

School Name and Address

Phone

High School Attended

Mailing Address

Year Graduated:

Year Graduated

College or University Attended

Dates of Attendance:

Major Field of Study

Minor Field of Study

Type of Degree

Year Earned

Student Teaching

Date:

Name of School

Address

Extra Curricular Activities You Can Direct

Yearbook

Newspaper

Cheerleading

Coaching

Other

Teaching Experience: List in chronological order.

From

Number of Years

Name and Address of School

Principal or Supervisor

Grade or Subject Taught

From

Number of Years

Name and Address of School

Principal or Supervisor

Grade or Subject Taught

From

Number of Years

Name and Address of School

Principal or Supervisor

Grade or Subject Taught

From

Number of Years

Name and Address of School

Principal or Supervisor

Grade or Subject Taught

From

Number of Years

Name and Address of School

Principal or Supervisor

Grade or Subject Taught

Non-Teaching Experience: List in Chronological Order.

From

Name of Employer

Address

Kind of Work

From

Name of Employer

Address

Kind of Work

From

Name of Employer

Address

Kind of Work

Are you willing to accept any assignment for the good of the school system, attend meetings or participate in other activities outside of school hours or Saturday mornings?

Have you ever failed to be reemployed?

Where?

If yes, please explain

Why do you wish to leave your present position?

On what date will you be available if offered employment at School Name?

Please state why you would like to teach at Catoosa Public Schools.

I understand that my application will remain active for one year and that I should notify Catoosa Schools, in writing, if I wish to be considered beyond that period. All persons, firms, and entities listed in this application are hereby authorized to release any information or records concerning me to the personnel department of Catoosa Public Schools and I hereby release said persons, firms, and entities from any liability as a result to the furnishing of such records and information. I certify to the best of my knowledge the facts set forth in my application are accurate and complete. I understand that falsifying information on this application will result in non employment or, after employment, discharge.

By Checking this box, I am certifying that all the above info is correct to the best of my knowledge.

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