HOQUIAM SCHOOL DISTRICT #28
HOQUIAM SCHOOL DISTRICT #28
305 Simpson Avenue, Hoquiam, WA 98550
Phone (360) 538-8200 Fax (360) 538-8202
An Equal Opportunity Employer
Application for Certificated Employment
_______________________________________________________________________
Welcome to our District!
All applications must include the following. Please call the personnel office if you have any questions.
a. A completed District Application
b. Letter of Interest
c. Current Resume
d. Copy of Valid Applicable Washington State Teaching Certificate(s)
e. Completed Applicant Disclosure Form
f. Official Transcripts from Colleges/Universities
g. College Placement File including Three Letters of Reference from your most recent employers/supervisors
h. Completed WA State Sexual Misconduct Form(s) prior to possible interview
All application materials become the property of Hoquiam School District #28 and will not be returned.
Federal and State criminal history background checks will be required of candidates who will or may have unsupervised access to children or developmentally disabled persons. Any offer of employment is conditional and subject to acceptable outcome of a criminal history background check, the return of the required WA state sexual misconduct form(s), and school board approval.
Visit our web site for additional information – .
Only completed applications will be considered.
Print or type.
Have you ever been employed in another school district? Yes No Most recent:______________________________
What is your current position:_______________________________ City/State:______________________________________
Position For Which You Are Applying Check:
Pre-School Teacher High School Teacher 9-12, Subject(s):_____________________________
Elementary School Teacher K-6 Middle School Teacher 7-8, Subject(s):____________________________
Administrator Counselor ESA
Program Administrator Substitute Other/Specify:____________________________
Educational Background: (Begin with the most recent)
Official Transcripts must be provided to verify college education.
Attach additional sheets as needed.
Student Teaching, Practicum or Administrative Internship:
Experience: Contractual Teaching/Administration - Begin with the most recent - Do not include substitute teaching
Attach additional sheets as needed.
Certification: Teaching, Administrative, and Special Certificates or Required Licenses
Other Experience: List other work experience, particularly any related to the position(s) for which you are interested
Attach additional sheets as needed.
References: Individuals with knowledge of your character, personality, scholarship and work ability
Extra Curricular: Which activities might you have an interest in directing or advising? Check all that apply
Personal Information:
1. Are you able to perform the duties and tasks of the position for which you are applying with or without accommodation or assistance?
________ With accommodation or assistance OR _______Without accommodation or assistance
If accommodation or assistance will be required, please explain how you would perform the duties/tasks, and with
what accommodations. __________________________________________________________________________
Are you fluent in another language? (please identify) ____________________________________________
Questions: In the space provided, please respond to each of the following:
Describe what makes you the best candidate for this position.
Describe an “effective” teacher.
Identify the key components of an effective lesson.
4. How might your supervisor assess your effectiveness?
Investigation Consent and Release of Liability Form:
I certify that all statements made by me on this application are true and complete. I understand that misrepresentation or falsification of statements made in the application constitutes grounds for immediate dismissal.
I authorize Hoquiam School District #28 to make an investigation of my personal, educational, vocational, or employment history. I further authorize any former employer, firm, corporation, educational or vocational institution, or government agency to provide Hoquiam School District #28 with any information they have regarding me. I hereby release and discharge Hoquiam School Districct #28 and all those who provide information from any and all liability as a result of furnishing and receiving this information.
______________________________________ ______________________________
Applicant’s Signature Date Signed
-----------------------
Legal Name: Last/First/Middle Date of Application
Other Name(s) under which records maybe listed Social Security Number
Complete Address: Both PO Box & Street Address Home Phone/Cell Number(s)
City State Zip E-mail Address
The Hoquiam School District prohibits discrimination on the basis of race, color, national origin, sex, sexual orientation including gender expression or identity, creed, religion, age, verteran or military status, disability, or the use of a trained dog guide or service animal by a person with a disability and provides equal access to the Boy Scouts of America and other designated youth groups. The Hoquiam School District is an equal opportunity employer and supports spirit, policies, and practices of state and federal laws prohibiting discrimination in keeping with the District’s Affirmative Action Plan. The District’s Title IX/RCW 28A.640 Officer is Mike Parker & Section 504 ADA Coordinator is Dr. Tricia Zurybida. Telephone Number: (360) 538-8200.
Institutions Attended Dates Major/Endorsement Degree Date of Degree
School and Location Grade or Subject Name of Supervisor Dates
School and Location Grade/Subject Dates Reason for Leaving
Type Certificate Number State Issue Date Expiration Date
Endorsements: 1.______________________________________ 2._________________________________________
3.______________________________________ 4._________________________________________
Employer Address/City/State Position Dates Reason for Leaving
Name Title/Position Address Phone
____ASB Advisor ____Cross Country ____Golf ____Track
____Baseball ____Drama ____Knowledge Bowl ____Volleyball
____Basketball ____Fastpitch ____Journalism ____Wrestling
____Cheerleader Advisor ____Football ____Soccer ____Yearbook
____Club Advisor ____Other (specify) ____Swimming
The Hoquiam School District complies with all federal and state rules and regulations and does not discriminate on the basis of race, color, national origin, sex, sexual orientation including gener expression or identity, creed, religion, age, veteran or military status, disability, or the use of a trained dog guide or service animal by a person with a disability and provides equal access to the Boy Scouts of America and other designated youth groups. This holds true for all district employment and opportunities. Inquiries regarding compliance and/or grievance procedures may be directed to the school district’s Title IX/RCW 28A.640 compliance officer, Mike Parker & Section 504/ADA coordinator, Dr. Tricia Zurybida. Telephone Number: (360) 538-8200.
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