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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