The School Administrative District does not discriminate in the operation of its educational and employment policies and will honor all appropriate laws relative to discrimination.
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Date____________________________________ Position(s) applying for: (Grade level,
subject)
Name___________________________________ __________________________________________
Social Security No. ______-_______-________ __________________________________________
When will you be available?_______________ __________________________________________
Permanent Address__________________________________________ Phone___________________
Temporary Address__________________________________________ Phone___________________
EDUCATION:
Transcripts, including grades, from all college(s)/university(s)
attended must be provided. It is essential
that this section be completed accurately.
No.
of Yrs.
College/University Attended Degree
Awarded(if any) Attended Grade Point Avg.
_______________________________ ____________________ _________ _______________
_______________________________ ____________________ _________ _______________
_______________________________ ____________________ _________ _______________
_______________________________ ____________________ _________ _______________
Number of semester hours in:
_____________Reading __________________Major
(Subject:__________________)
_____________Math __________________Major
(Subject:__________________)
_____________Special
Education __________________Major
(Subject:__________________)
__________________Minor
(Subject:__________________)
CERTIFICATION:
List certification(s) you hold and provide copies of certification.
Type State Date
Issued Date of Expiration
_____________________________ _____________________ __________ ________________
_____________________________ _____________________ __________ ________________
_____________________________ _____________________ __________ ________________
_____________________________ _____________________ __________ ________________
If you hold a Maine certificate, for what type of Maine
certificate are you applying and eligible?________
______________________________________________________________________________________________________________________________________________________________________________
Note: Candidates
who do not hold
EXPERIENCE: A resume must be provided. In addition to educational background and
work experience, include extra-curricular activities in which you have been
involved. Please list below positions
held, employer, and dates of employment for the past ten years. Please account for any gaps in employment on
a separate page.
From (month/year) To(month/year) Position Employer
______________ ____________ ________________________ _______________________
______________ ____________ ________________________ _______________________
______________ ____________ ________________________ _______________________
______________ ____________ ________________________ _______________________
Number of years to teaching
experience______. On a separate sheet,
please describe a specific class or class activity you planned and actually
conducted which illustrates your philosophy of teaching and is the best example
of your teaching skill. What evidence
showed you that this class or activity was successful in terms of student
motivation and achievement?
BACKGROUND:
Have you ever been disciplined,
discharged, or asked to resign from a prior position? Yes____ No____
Have you ever resigned from a
prior position after a complaint had been received against
you or your conduct was under investigation
or review? Yes____No____
Has your contract in a prior
position ever been non-renewed? Yes____No____
Have you ever not been nominated
for re-employment in a prior position or ever had
your nomination for re-employment
not be approved? Yes____No____
Have you ever been charged with or
investigated for sexual abuse or harassment of
another person? Yes____No____
Have you ever been convicted of a
crime (other than a minor traffic offense)? Yes____No____
Have you ever entered a plea of
guilty or “no contest” (nolo contendere) to any crime
(other than a minor traffic
offense)? Yes____No____
Have you ever had a professional
license or certificate suspended or revoked in any state,
or have you ever voluntarily
surrounded, temporarily or permantely, professional license
or certificate in any state? Yes____No____
Has any court ever deferred, filed
or dismissed proceedings without a finding of guilty
and required that you pay a fine,
penalty or court costs and/or imposed a requirement
as to your behavior or conduct for
a period of time in connection with any crime
(other than a minor traffic
offense)? Yes____No____
If you have answered YES to any of the previous questions,
provide full details on an additional sheet including, with respect to court
actions, the date, offense in questions, and the address of the court
involved. Conviction or other disposition
of a crime is not necessarily an automatic bar to employment.
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REFERENCES: List
three, two of who are most recent supervisors, who can comment on your ability
and whom we may contact. In addition,
please provide three letters of reference from persons who are not related to
you (may be from references listed below).
Name Position Address Telephone
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
SIGNATURE:
My signature below constitutes authorization to check my
employment history, including without limitation, criminal arrest and
conviction record checks, reference checks, and release of investigatory
information possessed by any state, local or federal agency. I further authorize those persons, agencies
or entities that SAD #4 contacts in connection with my employment application
to fully provide SAD #4 any information on the matters set forth above. I expressly waive in connection with any
request for or provision of such information, any claims, including without
limitation, defamation, emotional distress, invasion of privacy, or
interference with contractual relations that I might otherwise have against
SAD#4 its agents and officials or against any provider of such information.
I understand that information submitted in and with this
application may be disclosed to a screening and/or interviewing committee,
which may include board members, administrators, other staff, and members of
the community. I give my consent to this
disclosure.
___________________________________
Signature/Date
APPLICATION FOR TEACHING POSITION CHECK LIST: The completed employment application cannot
be evaluated unless all of the following materials have been provided:
________ Application form fully completed
________ Copies of Transcript(s)
________ Copy of Maine Certification(s)
________ Resume
________ Gaps in employment during the past ten years explained
________ Illustration of your philosophy of
teaching
________ YES to any of the questions in the
Background section explained
________ Three letters of reference
________ Application signed
NOTE: ALL
APPLICATION MATERIALS BECOME THE PROPERTY OF SAD #4. NONE WILL BE RETURNED. PROVIDING ANY FALSE OR MISLEADING INFORMATION
ON THIS APPLICATION OR IN THE APPLICATION OR EMPLOYMENT SCREENING PROCESS SHALL
BE FULLY SUFFICIENT GROUNDS TO REFUSE TO EMPLOY THE APPLICANT OR, IF THE
APPLICANT HAS BEEN EMPLOYED, TO IMMEDIATELY DISMISS THE APPLICANT/EMPLOYEE.
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