EducationAL BACKGROUND (IN ORDER, BEGINNING WITH HIGH ...



DO NOT WRITE IN THIS SPACEReceived by _______________Date_____________________ Attach PhotographHereDEPARTMENT OF EDUCATION WASHINGTON COUNTY, TENNESSEEAPPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLTEACHERApplicant InformationLast NameFirstM.I.DateStreet Address Apartment/Unit #CityStateZIPPhoneE-mail AddressDate AvailableSocial Security No. POSITION DESIREDGRADE K GRADES 1-3GRADES 4-6GRADES 7-9 (SUBJECT)GRADES 10-12 (SUBJECT)1ST CHOICE2ND CHOICE3RD CHOICEAre you a citizen of the United States?YES FORMCHECKBOX NO FORMCHECKBOX If no, are you authorized to work in the U.S.?YES FORMCHECKBOX NO FORMCHECKBOX Have you ever worked for this company?YES FORMCHECKBOX NO FORMCHECKBOX If so, when?Have you ever been convicted of a felony?YES FORMCHECKBOX NO FORMCHECKBOX If yes, explainEducationAL BACKGROUND (IN ORDER, BEGINNING WITH HIGH SCHOOL) official Transcripts are requiredHigh SchoolAddressFromToDid you graduate?YES FORMCHECKBOX NO FORMCHECKBOX DegreeCollegeAddressFromToDid you graduate?YES FORMCHECKBOX NO FORMCHECKBOX DegreeOtherAddressFromToDid you graduate?YES FORMCHECKBOX NO FORMCHECKBOX Degree CERTIFICATIONnAME (As listed on certificate) typeNumber Date Issued Expiration Date SubjectsDO NOT WRITE BELOW LINE_____________________________________________________________________*Applications will be retained for a period of one year from the date of receipt.*Application Acknowledged_________________________ References sent_________________________________Interview (s) Scheduled:_____________________________________Previous EmploymentCompanyPhone( )Address City StateSupervisorJob TitleResponsibilitiesFrom ToReason for LeavingMay we contact your previous supervisor for a reference?YES FORMCHECKBOX NO FORMCHECKBOX CompanyPhone( )Address City StateSupervisorJob TitleResponsibilitiesFrom ToReason for LeavingMay we contact your previous supervisor for a reference?YES FORMCHECKBOX NO FORMCHECKBOX CompanyPhone( )Address City StateSupervisorJob TitleResponsibilitiesFrom ToReason for LeavingMay we contact your previous supervisor for a reference?YES FORMCHECKBOX NO FORMCHECKBOX referencesPlease list references.Full NameRelationshipCompanyPhone( )Address Full NameRelationshipCompanyPhone( )AddressFull NameRelationshipCompanyPhone( )AddressTEACHING EXPERIENCE- Regular or full time only (List in order, beginning with most recent)SCHOOLADDRESSPRINCIPALGRADE AND/OR SUBJECTSCHOOL YEARTOTAL MONTHSMILITARY SERVICE: FROM: TO: TOTAL:BranchDateYearsSTUDENT TEACHING (FOR APPLICANTS WITH LESS THAN TWO YEARS EXPERIENCESchool___________________________________ Grade or Subject______________________________ Date____________________SUPERVISING TEACHER_____________________________ Address______________________________________________________ARE YOU PREPARED TO?Elementary(a) Teach the children in your room Art? Music? Phys. Ed.?Secondary(b) Sponsor any activities? (Circle at least one) Annual, Paper, Forensic, Music, Cheerleaders, Senior Class, Drama, Service Club, Athletics (SpecifySubject Matter Club, Other IN YOUR HANDWRITING, MAKE A BRIEF STATEMENT ON WHY YOU HAVE CHOSEN TEACHING AS A PROFESSIONDISCLAIMERI recognize that, if I am employed, the Board of Education of Washington County will assign or reassign me to a specific position as the need requires.I hereby certify that I (have) (have not) been convicted of a misdemeanor or a felony in any state of the United States.If “have” is indicated, explain fully the details of each such conviction on a separate sheet of paper.I further certify that I (have) (have not) been dismissed from any previous employment for improper or unprofessional conduct, inefficient service, neglect of duty, incompetence, or insubordination as the same are defined in Section 49-1401 of the Tennessee Code.If “have” is indicated, explain fully the details of each such dismissal on a separate sheet of paper. The employer’s non-renewal of a yearly contract need not be indicated unless the non-renewal was for cause as listed above.If my most recent employer were another Tennessee public school system and if my termination were voluntary, I hereby certify that my resignation was, or will be submitted at least 30 days prior to the beginning date stated hereon; or, if within 30 days, that the previous board has waived its’ right to such notice. A copy of my letter of resignation or of the said board action is attached or will be provided.I understand that misrepresentation of any of these certifications may subject me to the penalties prescribed in Sections 49-1317 or 49-1318 of the Tennessee Code.(Signed) (Typed or Printed)Please Return This Application to:Washington County Board of Education405 W. College St.Jonesborough, TN 37659NOTE:The Washington County Department of Education requires the following:1.(a)A completed application(b)At least a Bachelor’s Degree(c)College transcript(s) (d)A Tennessee Teacher’s Certificate(e)A recent photograph(f)A current background check 2.The applicant must be interviewed in person.3.All documents filed herewith (except teacher’s certificate) become the property of the Board of Education, Washington County, Tennessee.4.No reimbursement for expenses for applicant will be granted.5.Successful applicants shall present a Physician’s Certificate showing satisfactory health record. District personnel shallrespect the individual’s right to privacy and treat any medical diagnosis as confidential information. AN EQUAL OPPORTUNITY EMPLOYERIt is the policy of the Department of Education to recruit, hire, and promote in all job classifications without regard to race, color, religion, sex, national origin, age, or handicapping conditions, except where it is necessary to meet a bona fide confidential qualification, DOE Form PER 112 (13 Aug 81) ................
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