Certified Employment Application

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Position you are applying for *

Full Name *

Address *

City, State and Zip *

Phone Number *

Email *

Available Start Date

YYYY

Are you a citizen of the United States? *

Yes

If no, are you authorized to work in the United States?

Yes

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Have you ever worked for USD 378? *

Yes

If yes, when?

Are you currently licensed in Kansas? *

Yes

If no, are you in the process of obtaining Kansas Licensure?

Yes

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How many years of experience do you have in the education profession?

Have you even been convicted of, or are you charged with, a crime for other than a minor traffic violation? *

Yes

If yes, please explain

Have you ever entered into a criminal diversion agreement after being charged with any offense involving dishonesty, controlled substances, crimes involving a child, or for any crime other than a minor traffic violation? *

Yes

Are criminal charges pending against you in any state involving offenses described in the previous question? *

Yes

Have you ever had a teacher, school administrator's certificate, or license denied, suspended, or revoked in any state? *

Yes

Is disciplinary action pending against you in any state regarding a teaching or administrator's license or certificate? *

Yes

If yes to any of the above, please explain

Please list any languages you are proficient in (other than English)

College or University holding your credentials:

What is your philosophy of education? *

Why are you the best candidate for a position in your area of endorsement(s)? *

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