USD 216 Certified Application for Employment

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PERSONAL INFORMATION

Name *

Please provide your first, middle and last name

Date *

YYYY

Present Address (Street, City, State, Zip Code) *

Email *

Phone number *

EMPLOYMENT DESIRED

Which open position(s) are you interested in? *

Please list grades and/or subjects and levels in order of preference

Date of Application: *

YYYY

Are you interested in coaching or being a sponsor? *

Yes

Maybe

This application will not be considered complete until transcript and credentials are on file with Deerfield USD #216

EDUCATION ATTAINED

Please list the schools you have attended and your degree of study, starting with the most recent

School Attended & Degree of Study: *

Graduation Date: *

YYYY

School Attended & Degree of Study: *

Graduation Date: *

YYYY

School Attended & Degree of Study: *

Graduation Date: *

YYYY

School Attended & Degree of Study: *

Graduation Date: *

YYYY

CERTIFICATIONS

Please list all current teaching certifications and levels: *

PREVIOUS TEACHING EXPERIENCE

Include Student Teaching if you are a new or recent graduate

Please list your previous school of employment and your reason for leaving: *

Teaching Duties: *

Length of time employed: *

Annual Salary: *

Please list your previous school of employment and your reason for leaving: *

Teaching Duties: *

Length of time employed: *

Annual Salary: *

Please list your previous school of employment and your reason for leaving: *

Teaching Duties: *

Length of time employed: *

Annual Salary: *

CURRENT AND FORMER EMPLOYERS

Current Employer: *

Are you currently under contract? *

Yes

If so, when does your contractual obligation expire?

YYYY

Are you certified to teach in Kansas? *

Yes

REFERENCES

Please list the name, occupation, address, phone number, and relationship of three persons not related to you, whom you have known for at least one year.

Reference #1 *

Reference #2 *

Reference #3 *

Do you have any health conditions that would prevent you from performing any of the tasks required by this position? *

Yes

Maybe

If yes or maybe, please explain:

Have you ever been convicted of any felony involving another person, any crime involving a child, or any major traffic violations? *

Yes

By signing this application, I agree to allow Deerfield USD 216 to submit my name to the Kansas Bureau of Investigation for a criminal record, and to the Kansas Driver's Licensing and Control, Topeka Kansas for a driving record.

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered my application may be rejected. *

Yes

Required

AN EQUAL EMPLOYMENT/EDUCATION OPPORTUNITY AGENCY

Unified School District #216 does not discriminate on the basis of race, color, national origin, sex, age, or disability in admission or access to, or treatment or employment in, its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. Any person having inquiries concerning Unified School District #216 compliance with the regulations implementing Title VI, ADA, Title IX, or Section 504 is directed to contact the Unified School District #216, Superintendent of Schools, tyson.eslinger@usd216.org, 803 Beech St., Deerfield, Kansas 67846, 620-426-8516.

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