MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C67029.9E76BE70" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C67029.9E76BE70 Content-Location: file:///C:/0C4BB24E/application.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" LCBOE Application for Employment

PROFESSIONAL PERSON= NEL

APPLICATION FOR EMPLOYMENT

LAKE COUNTY BOARD OF EDU= CATION

 

I am applying for employment as        =             &nb= sp;       to begin   &nb= sp;            =

        =             &nb= sp;            =        position        =             &nb= sp;     date/term

 

Area(s) of Endorsement        =             &nb= sp;    Teacher #   &n= bsp;            = ;           

 

1.  I recognize that, if I am employed= , the Board of Education may assign or reassign me to a specific position as the = need requires and that my salary would be according to state salary schedule plus any local supplements.

 

2.  I have not been convicted of a misdemeanor or felony in any state of the <= st1:place w:st=3D"on">United States. (does not incl= ude parking or moving traffic violations if the maximum sanction provided by law for such violations does not include a period of confinement.)

 

3.  I have not been dismissed from any previous employment for improper or unprofessional conduct, inefficient service, neglect of duty, incompetence, or insubordination.

 

4.  If my most recent employer was ano= ther Tennessee public school system and if my termination was voluntary, I certi= fy that my resignation was, or will be submitted in writing at least thirty (3= 0) days prior to the beginning date stated; or if within thirty (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.

 

5.  I am a citizen of the United States.

 

6.  I do not advocate the overthrow of= the American form of government nor am I a member of a political party which advocates the overthrow of the American form of government.

 

7.  I do not have any contagious or communicable disease which may endanger the health of school children and if elected agree to undergo a physical examination at my own expense prior to = school opening.

 

8.  I shall support the constitutions = of Tennessee and the U= nited States and will abide by the laws governing the educational policies of Tennessee and Lake County.

 

9.  I understand that misrepresentatio= n of any of the above statements may subject me to a fine, loss of an opportunity for employment, and loss of position if employed.

 

The undersigned hereby certifies that the foregoing information is true and cor= rect and fully understands that falsification of this application will be cause = for rejection of the application and/or discharge.  Further, the undersigned hereby ag= rees to release all investigative records to the local Board of Education for examination for the purposes of verifying the accuracy of criminal violation information and to supply a fingerprint sample and submit to a criminal his= tory records check to be conducted by the Tennessee Bureau of Investigation.

 

Full Name (Please Print) ___________________________________________________________<= /span>

        =             &nb= sp;             

Signature         = __________________________________________________________________

  <= span style=3D'font-size:10.0pt;mso-bidi-font-family:Courier'><= /b>

Address        =             &nb= sp;           City         =         State,Zip            =   

 <= /b>

Phone Number        =             &nb= sp;     Date        &= nbsp;           &nbs= p;            &= nbsp; 

 

Is there any accommodation you may need to perform the essential functions of = the position for which you are applying? =   (Americans With Disabilities Act)

(optional)      yes=       No

If so, please explain:        =             &nb= sp;            =             &nb= sp;           

        =             &nb= sp;            =                  =             &nb= sp;            =     <= /b>

 

PLEASE NOTE: This application will remain active for one calendar year.  If the applicant desire= s this application to remain active for an additional year, he/she should submit a written request to this office.               =             &nb= sp;           

        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =   

 

  &nbs= p;          &= nbsp;           &nbs= p;             =         

Tenn= essee Teacher License Number       

 =

Attach<= /p>

Photo

Here

[Option= al]
 
   &n= bsp;            = ;            &n= bsp;             =                      =        

Date

 

  &nbs= p;            &= nbsp;           &nbs= p;       

Last Name       First Name    MI       

 

Date Available for Employment   &nbs= p;            &= nbsp;  ______        =  

 

Social Security #      = ;            &n= bsp;            = ;              =             &nb= sp;         =             &nb= sp;            =   

 <= /span>

Race         (Optional)

 <= /span>

 <= /span>

 <= /span>

Present Address:        =             &nb= sp;    Permanent Address:

 <= /span>

__________________= _________________       _____= ______________________________

Street        &= nbsp;           &nbs= p;            &= nbsp;  Street

 <= /span>

__________________= _________________       _____= ______________________________

City, State, Zip        &= nbsp;           &nbs= p;     City, State, Zip

__________________= _________________       _____= ______________________________

Phone        &= nbsp;           &nbs= p;            &= nbsp;   Phone

 <= /span>

 <= /span>

 

 

=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D

=         &= nbsp;           &nbs= p;       POSITION DESIRED

=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D

 

 

Grades

 

K-1

 

 2-3=

 

 4-6=

 

  &nbs= p; 7-8 (Subject)

 

   9-12 (Subject)

 

1st Choice

 

 

 

 

 

 

 

 

 

 

 

2nd Choice

 

 

 

 

 

 

 

 

 

 

 

3rd Choice

 

 

 

 

 

 

 

 

 

 

=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D

 

 

 

 

 

 

 

 

 

=       EDUCATIONAL BACKGROUND (in order beginning with high school)

=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D

 

 

       Sc= hool

 

  Lo= cation

 

 Degree/HSDiploma

 

Date

 

Major

 

Minor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The school system does not discriminate on the basi= s of age, sex, race, color, creed, religion, national origin, or disability in t= he operation of its educational programs and activities, including employment practices.

 

 

 

 

        =             &nb= sp; 

<= span style=3D'mso-tab-count:1'>        &= nbsp;      TEACHING EXPERIENCE-REGULAR, full time only

<= b>        &= nbsp;      (List in order beginning with most recent)

 

=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D

 

 

School

 

Address

 

Principal

 

Grade/

Subject

 

School Year(s)

 

Total Months

 

Last

Annual Salary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D

 

 

 

 

 

 

 

 

      OTHER W= ORK EXPERIENCE (List in order beginning with most recent)

 

 Type o= f Work

 

   &= nbsp; Name and Address

    of Firm or Employer

 

Date

 

Last Annual Salary

 

 

 

 

 

From

To

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

From

To

 

 

=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D

 

 

Military Service        =              From        =    To _______________        =   

        =            [Branch]          =       

Total Years Experience ____________________________________

 

        =             &nb= sp;          =         =             &nb= sp;  

=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D= =3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D

 

 

<= span style=3D'mso-tab-count:1'>        &= nbsp;           &nbs= p;          REFERENC= ES

 

       &nbs= p;  Name

 

       &nbs= p; Address

 

   &= nbsp; Position

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRACTICE TEACHING

        (For applicants with less than two years experience)

School________________= ____________________________________________

        =             &nb= sp;     

Grade or Subject        __________________________________________

 

Date ____________________= _________________________________________

        =      

Supervising Teacher ______________________________________________        =          

 

Address__________________= _________________________________________        =             &nb= sp;               <= /span>        =             &nb= sp;            =             &nb= sp;            =           =             

 

 

 

Courses Taken in College or University

(Attach transcript)

 

 

Activities (High School, = College, and since)     =                   ______________

 

            =             &nb= sp;            =       _____________        &= nbsp;       ____

 

            = ;            &n= bsp;            = ;            &n= bsp;             ______________        =             &nb= sp; 

        =             &nb= sp;            =             &nb= sp;            =         

        =             &nb= sp;            =             &nb= sp;            =       

Travel, Honor, Offices (C= ollege and since)     =                 ______________

 

            = ;            &n= bsp;            = ;            &n= bsp;             ______________

 

            = ;            &n= bsp;            = ;            &n= bsp;             ______________        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =     

        

Organizations:

(a)  Professional            =             &nb= sp;          

        =             &nb= sp;            =      

(b)&= nbsp;         Civic&nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   

             =             &nb= sp;            =             &nb= sp;

 

Are you prepared to:

 

 Elementary  [Check all that apply]<= /i>

 

(a) Teach the students in= your room-Art?    = Music?    Phys.Ed._____?<= span style=3D'mso-spacerun:yes'>  

 

 Secondary<= /i>

 

(b) Sponsor any activitie= s? (Circle at least one). Annual, Newspaper, Forensic,     Music, Drama, Cheerleaders, Senior Class, Serv= ice Club, Coach

 

     Specify        =             &nb= sp; Club,

           &n= bsp;  Subject Matter

Other         =             &nb= sp;         =             &nb= sp;            =          

 

 

In your handwriting, make= a brief statement on why you have chosen teaching as a profession.

 

 

 

 

        =             &nb= sp;            =             &nb= sp;          

 

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