Certified Application for Employment

Certified Application for Employment
POLICY STATEMENTS AND QUESTIONS
1. A resume should be placed on file for this application to be considered complete.
2. Personal interviews will be arranged by the personnel office upon request by the site principal. You will receive no further reply unless you are being considered for a specific position.
3. This application will remain on file for one year (July 1 through June 30th). It must be renewed at that time, if so desired.
4. Each applicant should edit the data provided most carefully before submitting this form.
Name*

First NameLast NameOther Name or Middle Initial
Email Address*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date*

MonthDayYear
Date
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you agree to provide information regarding citizenship status as required by law?*
Have you ever been convicted of a felony?*
FIELDS OF SERVICE PREFERRED
First Choice: grade level Grade level* subject area Subject area*
Second Choice: grade level Grade level* subject area Subject area*
Please place a check box next to each school site for which you would be willing to seek employment. (please select all that apply)*

Elementary (PK-2)Upper Elementary (3-6)Middle School (7-8)High School (9-12)District
Please select which position(s) you are interested in apply for:

PrincipalAthletic DirectorFull-Time Teaching PositionSubstitute Position
INSTITUTIONS OF HIGHER LEARNING ATTENDED

Rows	Name	Subject/Major/Minor	Dates	Degree/Year Conferred
School 1
School 2
School 3

CERTIFICATION

Rows	Certificate(s) held	Date of Issuance	Expiration
Certificate 1
Certificate 2

EXPERIENCE IN SCHOOL WORK

Experience in school work, as requested hereunder, should include only teaching or administrative experience in a duly accredited private or public school, college, or university, on a regular full-time basis as accepted by the Oklahoma State Department of Education. Do not include part-time substitute or student teaching experiences.

Rows	Schools	Location	State	Date	Number of Years	Subject or Grade Taught or Other Assignment
Location 1
Location 2
Location 3
Location 4
Location 5
Location 6

STUDENT TEACHING EXPERIENCE
Grade level/subject
Name of School
Name of Supervisory Teacher
Name of School Principal
College/University
Supervising Professor
EXTRA CURRICULAR PREFERENCE
Please indicate any preferred extra curricular areas you would consider directing or sponsoring:
MISCELLANEOUS
Are you related in any way to a member of the Kellyville Board of Education or employee(s) of Kellyville Public Schools?*

YesNo
If you answered "Yes" to the aforementioned question, please indicate who and explain the relationship. In the case of an employee, please indicate employee's present assignment.
REFERENCES
University address and phone number where placement file is located: (if applicable)
University
Phone Number
University Address

References submitted should consist preferably of school people. Experienced teachers should submit names of former principals or supervisors and inexperienced teachers should submit names of supervising teachers in their student teaching experience. *

Rows	Name	Email Address	Position	Phone
Reference 1
Reference 2
Reference 3
Reference 4

RESUME
Please attach your resume below.

Cancelof
In order that the officials of the Kellyville Public Schools may be fully informed as to my personal character and qualifications for employment, I hereby authorize the Kellyville Public Schools to contact any former employer or other person whom they wish to contact concerning my personal character and qualifications and I hereby release any such persons and the Kellyville Public Schools from any and all liability for information provided or obtained as result of these inquiries.

I understand that any false information or misrepresented information contained in this application may be grounds for my immediate termination.
Date*

MonthDayYear
Date
Signature of Applicant*

Clear
The Kellyville School District does not discriminate on the basis of race, creed, color, sex, age, national origin, handicap or veteran status.
Should be Empty:

Certified Application for Employment

FIELDS OF SERVICE PREFERRED

INSTITUTIONS OF HIGHER LEARNING ATTENDED

CERTIFICATION

EXPERIENCE IN SCHOOL WORK

STUDENT TEACHING EXPERIENCE

EXTRA CURRICULAR PREFERENCE

MISCELLANEOUS

REFERENCES

RESUME