Certified Employment Application
Position you are applying for *
Your answer
Full Name *
Your answer
Address *
Your answer
City, State and Zip *
Your answer
Phone Number *
Your answer
Email *
Your answer
Available Start Date
MM
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DD
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Are you a citizen of the United States? *
If no, are you authorized to work in the United States?
Have you ever worked for USD 378? *
If yes, when?
Your answer
Are you currently licensed in Kansas? *
If no, are you in the process of obtaining Kansas Licensure?
How many years of experience do you have in the education profession?
Your answer
Have you even been convicted of, or are you charged with, a crime for other than a minor traffic violation? *
If yes, please explain
Your answer
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? *
Are criminal charges pending against you in any state involving offenses described in the previous question? *
Have you ever had a teacher, school administrator's certificate, or license denied, suspended, or revoked in any state? *
Is disciplinary action pending against you in any state regarding a teaching or administrator's license or certificate? *
If yes to any of the above, please explain
Your answer
Please list any languages you are proficient in (other than English)
Your answer
College or University holding your credentials:
Your answer
What is your philosophy of education? *
Your answer
Why are you the best candidate for a position in your area of endorsement(s)? *
Your answer
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