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171450558800David GraySuperintendent of Schools020000David GraySuperintendent of Schoolsleft0 SEQ CHAPTER \h \r 1Morehouse Parish School System00 SEQ CHAPTER \h \r 1Morehouse Parish School System4514850531495Teresa Merritt Personnel Supervisor & Talent Pipeline LEAD00Teresa Merritt Personnel Supervisor & Talent Pipeline LEAD center14224000 center184150 SEQ CHAPTER \h \r 1Application for Certified Positions 00 SEQ CHAPTER \h \r 1Application for Certified Positions OFFICE USE ONLYDate Received: ____ Application Received by: ________________________Applicant Name: _________ Type Certificate:A B C Level 1 2 3 PL 1 2 3 Out of State Other: _____________________ Area(s) of Certification: ___________ Application forwarded to :____ Delta Elementary Date: _______________________ Morehouse Elementary Date: _______________________ Morehouse Magnet Date: _______________________ Bastrop High School Date: _______________________ Student Services Date: ________________________Other _______________________ Date: _____________________Application For:?Teacher ?Ancillary Position?Pupil Appraisal?Other Please attach a copy of the following: ___ Official college transcript___ Current teaching certificate, ancillary license, or other certifications ___ Praxis scores ___ Current Program plan (if currently enrolled in a teacher preparation program)34385254188460C:\Users\teresa.merritt\Desktop\Work computer\On Desktop\Personnel Matters\Forms 05/202000C:\Users\teresa.merritt\Desktop\Work computer\On Desktop\Personnel Matters\Forms 05/2020-85725-209550MPSB Application for Certified Positions Page 1 of 7400000MPSB Application for Certified Positions Page 1 of 7Morehouse Parish School System Application for Certified PositionsP.O. Box 872 4099 Naff Avenue Bastrop, Louisiana 71220 Central Office (318) 281-5784 Personnel Office (318) 283-3482 Fax (318) 281-9919Website: mpsb.us Email: personnel@mpsb.us SEQ CHAPTER \h \r 1 NOTICE TO APPLICANTThe Morehouse Parish School System does not knowingly discriminate against any employee or applicant for employment on the basis of race, color, religion, gender, age, national origin, handicap, or status as a Vietnam era or disabled veteran. This policy encompasses recruitment, selection, assignment, promotion, transfer, termination, compensation, training and apprenticeship, and all other terms, conditions, benefits and privileges associated with employment. This policy extends to the educational programs and activities operated by the state, districts, and schools. Discrimination is specifically prohibited by Title IX of the Education Amendments of 1972, as amended, and Title 45, Subtitle A, Part 66, of the implementing regulations administered by the Director of the Office of Civil Rights of the United States Department of Health, Education, and Welfare.Section IPersonal InformationName: LASTFIRSTMIDDLECitizenship:?U.S.? Permanent ResidentSocial Security Number: Have ever been known by any other name, including a nickname, another married name, or an alias? If so, list each such name separately._______________________________________________________________________________________________________________________________________________________________________________________________________Are you a citizen of the United States??Yes?NoIf no, do you have a legal right to work in this country? ?Yes?NoCurrent Phone Number: Alternate Number: E-mail Address: Permanent Mailing Address: Number and Street/Apartment Number CityStateZipHave you ever worked in a Louisiana School system? Yes? NoHave you ever applied for a teaching position in Louisiana? Yes? NoHave you ever applied for a non-teaching position in a Louisiana school system:? Yes? NoAre you retired from a Louisiana retirement system:? Yes? NoIf yes, name the school system from which you retired Date of Retirement: Are you currently certified for the position for which you are applying? ?Certified?Not Certified?Not Certified buy have appliedPreferred Assignment (Specify grade levels and subjects):1st Choice: 2nd Choice: 3rd Choice: Special Education Area(s):Vocational Education Area(s): If you also wish to be considered for a coaching assignment, list sports (with experiences and records) in order of preference: What student activities are you willing to sponsor? What proficiences do you have in computer technology? Section IIPosition DesiredMPSB Application for Certified Positions Page 2 of 7Section III Academic Record (beginning with the most recent experience)Institution and LocationDates of Attendance From ToDegree & DateAwarded orExpectedMajororField of StudyFull orPart TimeGPA in Major/GPA overallMo/YrMo/YrMo/YrMo/YrMo/YrMo/YrExplain any instances of probation, dismissal, and/or withdrawal from a course and/or failing grades. Also, describe any extenuating circumstances that may have affected your college grade point average (GPA). Section IVStudent Teaching Experience(beginning with the most recent) Complete this section ONLY if you completed student teaching within the last three years.Dates From To Name of School &School DistrictGrade(s) and/orSubject(s) TaughtName, Address, and Phone Number of Cooperating Teacher(s)Name, Address and Phone Number of University Supervisor(s)Mo/YrMo/YrMo/YrMo/YrMo/YrMo/YrSection VEmployment Information-Teaching Experience (beginning with the most recent)Dates From To Name of School &School DistrictGrade(s) and/orSubject(s) TaughtName, Address, and Phone Number of School District Reason forLeavingMo/YrMo/YrMo/YrMo/YrMo/YrMo/YrMo/YrMo/YrMPSB Application for Certified Positions Page 3 of 7Section VI Employment Information - Other than Teaching (beginning with the most recent)Include Part-time work and education related experiences.Dates From To PositionName, Address, & Phone Numberof Employer(s)Reason forLeavingMo/YrMo/YrMo/YrMo/YrMo/YrMo/YrSection VIICertification InformationDo you hold a valid Louisiana certificate?? Yes? No? No, but have applied If Yes, is your Louisiana certificate: ? Currentor? Expired?Louisiana Certificate: Type: Number: Issue Date: List areas of certification: Do you currently hold a valid certificate from another state? ? Yes ? No If Yes, indicate state: Out-of-State Certificate: Type: Number: Issue Date: List areas of certification: Do you hold National Board for Professional Teaching Standards Certification? ? Yes? NoAre you currently enrolled in an alternate certification program?________ If Yes, indicate University: ________________________Section VIII PRAXIS/NTE Scores.National Teacher Examination (NTE) If you have taken the NTE prior to 9/1/99 provide the following scores:Professional Knowledge:Date: Score: General KnowledgeDate: Score: Communication Skills: Date: Score: Speciality Area Test:Date: Score: Name of Test: PRAXIS Examination Complete the following if you have taken the Praxis on or after 9/1/99.PPST (Written Test)Computer Based TestReading:Date: Score: Reading:Date: Score: Writing:Date: Score: ORWriting:Date: Score: Math:Date: Score: Math:Date: Score: Principals of Learning and Teaching: Check the level taken: ? K - 6? 4 - 8? 7 - 1 2Date taken: : Score: Speciality Area Test(s) Name of Test: Test Code # Score: Name of Test: Test Code # Score: Name of Test: Test Code # Score: Name of Test: Test Code # Score: MPSB Application for Certified Positions Page 4 of 7Section IXExtra-Curricular Activities Beginning with the most recent, list up to four of the most significant activities and professional affiliations in which you have been most actively involved. Describe the nature of your involvement and/or anization NamePositionYearsAverage Hours per WeekDescription ofActivitySection XProfessional ReferencesNon-experienced teachers: References should include student teaching university supervisor(s), cooperating teacher(s) and school PrincipalsExperienced teachers:References should include principals, supervisors, and others who have observed and/or evaluatedyou most recently.Name & PositionName of School & DistrictComplete Mailing AddressTelephone Number(including area code)Section XIAdditional InformationIF YOU CHECKED YES FOR QUESTIONS 4, 5, 6 OR 7, explain in the space below or attach an explanation to this application: 8.Did you participate in the Louisiana Teacher Assistance and Assessment Program (L-TAAP)?? Yes? No If Yes, When: Where: Did you successfully complete the program?? Yes? No MPSB Application for Certified Positions Page 5 of 71.When will you be available? (month/day/year) Are you currently under contract? ? Yes? No If Yes, name of school system & expiration date: 2.Are you on approved leave from a school system? ? Yes? No If Yes,ending date of leave: and Type of Leave: 3.Are you related to an employee/board member of the Morehouse Parish School District? ? Yes? No If Yes, list the employee/board member's position and relationship:Employee's Position: Relationship: Employee's Position: Relationship: 4. Have you ever been convicted of a felony?? Yes? No 5.5. 5. Have you ever been convicted of an offense against the law or are you now under charges for any offense against the law?? Yes ? No (You may omit traffic violations other than convictions for driving intoxicated; any offense committed before your 17th birthday whi which which was finally adjudicated in a juvenile court or under a Youth Offender law.6.While in the military service were you convicted by a general court-martial?? Yes? No 7. Have you ever been terminated or recommended for dismissal by your employer? ? Yes? No 8. Within thirty-six months prior to your resignation, dismissal, or retirement from school employment was there any investigation of you for sexual misconduct or abuse or neglect with or against a minor or student? ? Yes ? No 9. Has there been an actual case or investigation of you for sexual misconduct or abuse or neglect with or against a minor or student? If formal allegation was inconclusive or unjustified it does not need to be reported. ? Yes? No10. Have you ever been found guilty of sexual misconduct or abuse or neglect with or against a minor or student? ? Yes? No Section XIIRelease of InformationRelease of Assessment and Evaluation InformationLa. R.S. 17:3884(D) requires that any school board wishing to hire a person who has been assessed or evaluated pursuant to the Children First Act, La.R.S. 17:3871, et seq.,whether that person is already employed by that school system or not, shall request such person's assessment and evaluation results as part of the application process. Please be advised that, as part of the mandated process, your previous assessment and evaluation results will be requested. You have the opportunity to apply, review the information received, and provide any response or information you deem appropriate.Misconduct DisclosureI authorize Morehouse Parish Schools to make investigations and inquiries of my personal, employment, and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, or persons from liability in responding to inquiries in connection with my application. School boards within Louisiana reserve the right to reject an incomplete application and further reserve the right to dispose of any application which is not current in a one-year period. References and personal information which become a part of this record are to be regarded as confidential and shall not be revealed to me. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employing authority, if employed.I certify that I have carefully reviewed the information in this application and that the information given in this application and in any supporting documentation and any resume I have provided and in any interview(s) which I may have given, is true and correct. I understand that any false information or wilful negligent or failure to disclose any requested information will constitute sufficient grounds to terminate my employment. I agree to submit to fingerprinting and a criminal background check and understand that provided that the Morehouse Parish School Board desires to employ me, my employment with the Morehouse Parish School Board depends upon the results of fingerprinting and criminal background check being acceptable to the Morehouse Parish School Board. I also affirm that I have never been convicted of a felony unless I have divulged it in writing to the Morehouse Parish School Board in connection with my employment application.I understand that failure to disclose information in Section XI on sexual misconduct or abuse or neglect will cause me to be charged according to the law in criminal court.Signature: Date: MPSB Application for Certified Positions Page 6 of 7Section XIII Written Narrative In your own handwriting, describe why you are seeking this position in Morehouse Parish. Morehouse Parish School Board is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, age, national origin, or disability in employment or the provision of services.Personal Information Form (for statistical use only)Morehouse Parish Schools is an Equal Employment Opportunity/Affirmative Action Employer. As such, each system is required by law to provide equal employment opportunities for all applicants without regard to race, religion, national origin, gender, age, or pletion of this information is used for Equal Employment Opportunity statistics and is not related to your application for employment. This information will be considered as part of your appplication and will only be used for statistical reporting purposes if you are employed. Thank you for providing the requested information.Name: LASTFIRSTMIDDLEETHNIC BACKGROUND: Check all that apply:? White (Non-Hispanic)? American Indian/Alaskan Indian? Black (Non-Hispanic)? Asian/Pacific Islander? Hispanic? Other HOW DID YOU HEAR ABOUT THE POSITION FOR WHICH YOU ARE APPLYING? Check all that apply.?Teach Louisiana Recruitment Center () ?Newspaper/Magazine (specify) ?Collegiate Career Services (specify) ?Job Referral Services (specify) ?School District Web Site?Other School District recruitment efforts (specify) ?Colleague/Friend/Family?Other (specify) GENDER:? Female? MaleBIRTHDATE: (month/day/year) ................
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