WEWOKA PUBLIC SCHOOLS P. O. Box 870 Wewoka, OK 74884 (405) 257-5475 Fax (405) 257-2303 “ An Equal Opportunity Employer

Employment Application for Use by Certified or Licensed Personnel

Name ___________________________________________________________________________________________

LAST FIRST MIDDLE

Address _________________________________________________________________________________________

Telephone _______________________________________________________________________________________

Military Status: Veteran? Yes ____ No ____ What Branch _________________________ Active Duty Dates _______ to _______

POSITION(S) FOR WHICH YOU ARE APPLYING: (Please list subject/grades in order of preference. List only those for which you are licensed or certified.)

Elementary School (K-5) ______________________________

Middle School (6-8) __________________________________

High School (9-12) ___________________________________

Administrative ______________________________________

Athletics ___________________________________________

Other (Specify) ______________________________________

Please list all approved teaching areas i.e. Certificate, License, Alternative Certification, etc. authorized by the Oklahoma State Department of Education. Include subject field endorsements for grades 7-12 as well as specific endorsements for counseling, special education, library, administration, and other school-related areas. Please attach a copy of your credential.

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Please answer the following questions:

1. Are you currently under contract? Yes___ No___ If yes, where?_________________________________

2. Do you have a relative currently on the Board of Education of Wewoka Public Schools?

Yes ___ No ___ If yes, please list his/her name(s) and relationship to you. ___________________________

3. When are you available to begin work?

_________________________________________________________

4. Is there any reason why you cannot consistently and promptly perform the duties of the job for which you are

applying? Yes ___ No ___ If yes, please explain: ______________________________________________________

5. Are you a citizen of the United States or a legal resident with proper authority to work in this country?

Yes ____ No _____

6. Have you ever been convicted of a felony or misdemeanor other than a minor traffic violation?

Yes ____ No ___ If yes, Please explain: ______________________________________________________

EDUCATIONAL BACKGROUND High School Location Dates of Attendance

_________________________________________________________________________________________

_________________________________________________________________________________________

Universities Location Dates of Attendance Degree(s)

_________________________________________________________________________________________

_________________________________________________________________________________________

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Major(s) _____________________________________ Minor(s) __________________________________

PROFESSIONAL EXPERIENCE (Please place student teaching on the top line.) School/District City/State Assignment(s) Supervisor Dates

________________________________________________________________________from_______to_______

________________________________________________________________________from_______to_______

________________________________________________________________________from_______to_______

________________________________________________________________________from_______to_______

Briefly describe the reason(s) why you left the positions listed above.

Related Work Experience: (List experiences related to education and youth.)

__________________________________________________________________________________________

__________________________________________________________________________________________

Other Information:

Please list any extracurricular positions or activities in which you may be interested.

__________________________________________________________________________________________

__________________________________________________________________________________________

Applicants may attach a separate resume or other documents. Your signature below indicates your affirmation the information contained in the application is true and complete to the best of your knowledge. Your signature further authorizes us to request pertinent confidential information from previous employers or educational institutions and allows other employers and Wewoka Public Schools supervisors to discuss your relevant employment characteristics as references.

________________________________ __________________________________________________ Date Signature of Applicant

Wewoka Public Schools is an equal opportunity employer and assures that there will be no discrimination against any employee or applicant on the basis of age, race, color, religion, sex, national origin, veteran status, or qualified handicap or disability. Transmission of this application shall be considered official and binding upon receipt of the district of the signature above by either original, fax, e-mail, or other electronic submission.

Pre Employment Application Wewoka Public Schools

I hereby authorize Wewoka Public Schools to verify the information I have provided in this employment application, in my oral statements and in any other documents or supplemental information I have provided to Wewoka Public Schools for the purpose of employment. I release Wewoka Public Schools and any employee acting on its behalf from any and all causes of action which may accrue to me as a result of said verification and disclosure of records or other information.

I certify that all information I have supplied to Wewoka Public Schools in this application and in any other form, oral or written, is true and accurate. I understand and agree that any misstated, misleading, incomplete, or false information is grounds for my disqualification from consideration for employment, for withdrawal of my offer of employment if an offer has been made, or for my immediate discharge if employment has already commenced, whenever, and however discovered.

I understand that nothing in this application is intended to imply or create an employment relationship or contract for employment.

______________________________________ Signature

______________________________________ Address of Applicant

______________________________________ Social Security Number