Iowa Teaching Application Page 1 of 4

Iowa Teaching Application

Page 1 of 4

General Information

Application Date:

Date Available:

First Name:

Middle Initial:

Last Name:

Are you eligible to work in the United States? Yes gfedc No gfedc

Current Home Phone:

Work Phone:

Permanent Phone: Current Address:

Permanent Address:

Position(s) for which you are applying:

Are you available full time? Yes gfedc No gfedc

Are you willing to consider less than full time? Yes gfedc No gfedc Are you under a teaching contract for next year? Yes gfedc No gfedc Where? Have you applied for your Iowa Teacher License? Yes gfedc No gfedc Iowa Folder Number: Do you hold a license from another state? Yes gfedc No gfedc If so, which state(s)? What certifications, endorsements or approvals have you achieved (including coaching authorization)?

Have you previously held a licensed position in an Iowa public school? Yes gfedc No gfedc District: Have you successfully completed an official probationary period in a public school district? Yes gfedc No gfedc If yes, what was the length of the probationary period?

Iowa Teaching Application

Page 2 of 4

Have you successfully completed a mentoring and induction program?

nmlkj

Yes

nmlkj

No

If yes, when?

nmlkj One year

nmlkj Two years but have been recommended for a

If

no,

have

you

completed:

third year nmlkj Three

years

and

am

not

being

recommended

for a professional license

nmlkj None

Are you on a sex offender registry? Yes gfedc No gfedc

Are you on the Department of Human Services' child abuse registry? Yes gfedc No gfedc

Have you ever been convicted of a felony or misdemeanor (excluding traffic violations)? Yes gfedc No gfedc

Please provide date, incident, city/state of charge:

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 and the position for which you are applying will be considered.

Are you able to perform, with or without reasonable accomodation, the essential job functions required of this position?

Yes gfedc No gfedc

If no, explain:

High School Attended: Have you served in the Military? Yes gfedc No gfedc If yes, I served in these wars and/or conflicts:

Location:

College:

Education Location:

Degree & Major/Minor:

Number of Hours Beyond Highest Degree:

Iowa Teaching Application Employment

School District/Employer: Employer Address:

Supervisor's Name: Date Worked From: Position:

Duties: Reason For Leaving:

School District/Employer: Employer Address:

Supervisor's Name: Date Worked From: Position:

Duties: Reason For Leaving:

School District/Employer: Employer Address:

Supervisor's Name: Date Worked From: Position:

Duties: Reason For Leaving:

Supervisor's Phone Number: Date Worked To:

Supervisor's Phone Number: Date Worked To:

Supervisor's Phone Number: Date Worked To:

Page 3 of 4

Iowa Teaching Application

Page 4 of 4

References

Reference's Reference's Name: Employer &

Address:

Reference's

Position:

Reference's Phone:

Home

Reference's Work Phone:

Application Verification

I hereby certify that the above information, to the best of my knowledge, is true, accurate and complete. Any misrepresentation or willful omissions of fact shall be sufficient cause for disqualification of this application or termination of employment. I authorize verification of any of this information. I authorize all current and former employers to release any information concerning my background. I understand that this application is not a contract of employment. I also understand that if hired, regardless of any oral representation to the contrary, the employment relationship is terminable-at-will.

SIGN HERE

Signature: _______________________ Date: _________

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