PDF ALLEN PARISH SCHOOL BOARD
ALLEN PARISH SCHOOL BOARD
P. O. DRAWER C 1111 WEST 7TH AVENUE OBERLIN, LOUISIANA 70655 PHONE (337) 639-4311 ? FAX (337) 639-2346
APPLICATION FOR EMPLOYMENT
(Teacher)
Personal Information
Name __________________________________________ Social Security # ____________________
(Last)
(First)
(Middle/Maiden)
Address ___________________________________________________________________________
(Mailing Address)
City
State
Zip
Telephone (Home) _______________________________________ (Cell) ______________________________________
Educational Information
Education High School
Name & Address of School
Year Graduated
Type of Degree
Major/Minor
Undergraduate College/University
Graduate College/University
Is your degree in education? If your answer is no, please specify.
__________________________________________________________________________________ __________________________________________________________________________________
Certification
Do you hold a Louisiana Teaching Certificate? Yes No Applied For Certificate Number _____________
List all areas of certification on your certificate: ___________________________________________________________ ___________________________________________________________________________________________________
Do you hold an Out-of-State Certificate? Yes
No Certificate Number/Issuing State ____________________
Are you currently on a TAT (Temporary Authority to Teach Certificate)? Yes
No
Are you currently on an OFAT? (Out of Field Authorization to Teach) Yes
No
List area/s ______________________________________________
Were you ever on an OFAT? Yes
No List parish/s __________________area/s____________________
Are you currently on a PL (Practitioner License)? Yes
No List type and area________________________
NTE/Praxis
Have you taken all parts of the NTE/Praxis? Yes
No
List Scores:
NTE: Communication Skills ___________ Professional Knowledge ____________ General Knowledge ___________
Specialty (score & area/s) ______________________________________________
Praxis: Pre-Professional Skills Test --- PPST:R ____________ PPST:W ___________ PPST:M_____________
Certification Area & Score _____________________________________________________________________
Principles of Learning & Teaching --- PLT K-6 ___________ PLT 5-9 ___________ PLT 7-12 __________
Teaching Experience
Indicate total number years of experience: ________
Allen Parish ________ Other Louisiana Public Schools ________ Private Schools ________ Out-of-State _________
Military Experience? Number of Years _____________ Dates _____________________________________________
(Can be paid for a maximum of four years, full-time active duty, military experience.)
If retired, list year and type: Year _________ Service
DROP
Disability
Out-of-State
Employment History (Please list all teaching experience. Official verification will be required for payroll.)
School System
Name of School/Address
Position Held Grade/Subject Taught
Dates (From...To)
Total Years
Reporting Information
Answers to the following questions are voluntary at this time and will not be used to make employment decisions. Answers will be required upon job offer and will be used for reporting purposes.
Date of Birth ___________________________
Sex __________
Race ___________________
Child Protection Act Information
Have you ever been convicted of a felony? Yes
No If yes, give offense, date, and outcome.
________________________________________________________________________________________________
Federal and state background checks are required by law.
Professional References Name
Address
Business
Phone Number
Certification of Accuracy
I hereby certify that the information and documentation contained herein and attached hereto are true and accurate to the best of my information, knowledge, and belief. I understand that any false or inaccurate information will result in my application being refused for further consideration and, if hired, will result in my immediate dismissal from employment.
________________________________________________________ (Signature)
____________________________ (Date)
Please attach a copy of your current teaching certificate and transcript.
The Allen Parish School Board is an equal opportunity employer, we are dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion, or national origin, or physical defects.
Allen Parish School Board
P. O. Drawer C 1111 West 7th Avenue Oberlin, Louisiana 70655 Phone: (337) 639-4311 Fax: (337) 639-2346
NAME:________________________________ SS# __________________________________
DATE: ____________________
The above perspective employee has released your school system to provide any and all information contained in their personnel files. This applicant has also released your school system, and any individual employee acting on behalf of your school system, to provide information on any instances of sexual misconduct with students. (See authorization signature below.)
1. Has this employee had any unsatisfactory annual evaluations with your system? _______
2. Has this employee ever been placed on intensive assistance/remediation with your system? ______ If so, for what? __________________________________________________ ______________________________________________________________________ ______________________________________________________________________
3. Has this employee committed any instances of sexual misconduct with students as defined by BESE? _____ If so, please attach copies of the documentation as required by state law.
Signature/Title of person completing information: ____________________________________ Name of School System: __________________________________ Date: _______________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I authorize the disclosure of information from any current or previous employer of mine, if such employer is/was a city, parish, or other local school board, relative to all instances of sexual misconduct with students committed by me, if any. I expressly give consent for the release of such information from any school employer regarding any personnel file maintained with respect to me. I release my current or previous employer, if employer is/was a city, parish or other local school board, and any employee acting on behalf of such employer from any liability for providing any information relative to all instances of sexual misconduct with students committed by me, if any.
I understand that if employed any misrepresentation or omission of facts requested in this application may be cause for dismissal. I further give my permission to the Allen Parish School Board to request any and all information contained in my personnel files with previous employers. Any offer of employment is contingent upon satisfactory references from previous employers contacted.
Signature________________________________________
Date _______________________
................
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