Chicago Area and Illinois Education Employment Interest Form

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By submitting this form, I hereby authorize the Illinois Education Deans to share the information provided herein with relevant departments, personnel, and decision-makers involved in the selection and hiring process. I understand that this information may be used to evaluate my qualifications and may be disclosed internally for academic and administrative purposes. I acknowledge that I am voluntarily providing this information and consent to its use as described.

Email *

What is your first name? *

What is your last name? *

Please select one of the following *

New Submission – This is my first time completing this form. Please add me to your list.

Update Existing Information – I have previously submitted this form and would like to update my details.

Request Removal – I have previously submitted this form and would like to be removed from the list.

What is the best phone number to reach you?
Format: 10 digits only (e.g., 3125551234). Do not include dashes, parentheses, or spaces. *

Please list your academic degrees along with the institutions where you earned them.

*

Please list which courses or topics you are interested in teaching, including your interest in field supervision in teacher or leadership preparation. *

What is your course delivery preference? Select all that apply. *

In-Person

Online Asynchronous

Online Synchronous

Field supervision in professional preparation

Required

What are your preferences related to availability? Select all that apply. *

Weekdays during the day

Weekdays in the evenings

Saturdays

Required

I am interested in supervision of field experiences (select all that apply):

In teacher preparation

In leadership preparation

In other professional educator preparation.

None of the above

Required

Do you have geographic preferences for areas of the state where you would like to work? Are you willing to consider working in locations beyond those preferred areas?

What languages do you speak? *

For the following questions, if they do not apply to you please enter N/A.

List the higher education institutions where you have experience teaching. *

List the titles of the post-secondary courses you have taught. *

List the PK-12 institutions where you have experience teaching and the grade levels, and if applicable, the specific content areas. Please also list the number of years of experience.

For example:

Washington High School, 9th grade mathematics, 5 years

Lincoln Elementary School, 3rd grade, 12 years

A copy of your responses will be emailed to the address you provided.

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