ODESSA-MONTOUR CENTRAL SCHOOL DISTRICT



Odessa-Montour Central School District

(607) 594-3341

Employment Application for Teachers/Administrators

Personal Information

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(First Name) (Middle Initial) (Last Name)

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Physical Address City State Zip

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Mailing Address (if different) City State Zip

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Home Phone Cell Phone Social Security # E-mail Address

|The Odessa-Montour Central School District is committed to a learning environment that actively supports all students, faculty and staff. The Odessa-Montour |

|Central School District is an Equal Opportunity Employer and complies with the Human Rights Laws of NYS and federal statutes including Titles, VI, VII and IX. |

|( |What position are you applying for? |      |

|( |Have you ever been fingerprinted through the NYS Education Department? | Yes No |

|( |Have you ever been granted tenure in New York State? | Yes No |

| |If yes, name of school: |      | | |

| |Tenure Area: |      |Effective Date: |      |

|( |Have you served in the U.S. Military? | Yes No |

| |Branch: |      |Dates of Service: |      |

Certification/License (attach copies)

|Subject/Grade Level |Type (temporary, permanent, etc.) |Number |Date Issued |State |

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To be included with this completed application:

← Letter of Interest ( Credentials from College Placement Office

← Current Resume ( Three Current Letters of Reference

( Copy of NYS Teaching Certificate(s) ( Official College Transcripts from Registrar’s Office

|Forward complete packet to: |

|Superintendent of Schools |

|300 College Avenue |

|Odessa, New York 14869 |

Education (“see resume” is not sufficient)

|High School/GED |Graduated |Major |Type of Degree, Diploma or Certificate |Total Credit Hours |

| |Yes |No | | | |

|Undergraduate | |Major |Type of Degree, Diploma or Certificate |Total Credit Hours |

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|Graduate | |Major |Type of Degree, Diploma or Certificate |Total Credit Hours |

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Teaching Experience (“see resume” is not sufficient)

|Employer Name |Address |Phone # |Name of Supervisor |Employment Dates |

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|Position: |Grades/Subjects: |Reason for Leaving: |# of Years: |

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|Employer Name |Address |Phone # |Name of Supervisor |Employment Dates |

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|Position: |Grades/Subjects: |Reason for Leaving: |# of Years: |

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|Employer Name |Address |Phone # |Name of Supervisor |Employment Dates |

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|Position: |Grades/Subjects: |Reason for Leaving: |# of Years: |

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|Employer Name |Address |Phone # |Name of Supervisor |Employment Dates |

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|Position: |Grades/Subjects: |Reason for Leaving: |# of Years: |

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Student Teaching Experience (“see resume” is not sufficient)

|School Name |Location |Grade/Subject |Supervising Teacher |Dates |

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Non-Teaching Work Experience (“see resume” is not sufficient)

|Employer Name |Address |Phone # |Name of Supervisor |Employment Dates |

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|Job Title: |Work Performed: |Reason for Leaving: |

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|Employer Name |Address |Phone # |Name of Supervisor |Employment Dates |

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|Job Title: |Work Performed: |Reason for Leaving: |

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|Employer Name |Address |Phone # |Name of Supervisor |Employment Dates |

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|Job Title: |Work Performed: |Reason for Leaving: |

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References

|Name |Position/Title |Address |Phone # |

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|Please write a statement covering additional points which will help in judging your suitability for a position, including such things as: (1) your aims in |

|teaching; (2) special experience, training or interests not mentioned elsewhere; (3) your teaching strengths and weaknesses. Attach additional pages if needed. |

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|What aspect of teaching gives you greatest satisfaction? Why? |

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|What recent innovations in education seem to be most exciting and promising? Why? |

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➢ Have you ever been denied tenure or dismissed from a teaching position? Yes No

➢ Have you ever resigned from a position rather than face disciplinary action? Yes No

➢ Are you now, or have you ever been, affiliated with a group which advocates

a belief in opposition to the Constitution of the United States? Yes No

➢ Have you ever been convicted of any crime, felony or misdemeanor? Yes No

➢ Was an investigation conducted or pending at the time of separation

from prior employment? Yes No

I hereby declare that the information provided by me is true, factual, and complete. I understand that false or incomplete statements or misrepresentations may disqualify me for employment or cause my subsequent dismissal. If employed by the Odessa-Montour Central School District, I understand I may be required to supply additional personal information for the purpose of determining my eligibility for benefits and for statistical data. I acknowledge that nothing in this application or in the Odessa-Montour Central School District hiring process creates a contract of employment and the Odessa-Montour Central School District, should I obtain employment, retains its right to terminate my employment in accordance with the law. I hereby authorize the Odessa-Montour Central School District to verify my credentials and investigate me (including a DMV check and a consumer investigative report) as allowed by law. This verification process may include discussions with references I have listed, coworkers, friends, business associates and others who the Odessa-Montour Central School District, in its sole judgment, believes has relevant information. I will not make any claims against the District or persons the District may contact during the investigation of references and my application in general. I hereby release the District and such persons from any and all claims related in any way to such reference checks or investigation of my application in general.

Signature________________________________________ Date________________

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