APPLICATION FOR CERTIFICATED EMPLOYMENT
CRAWFORD COUNTY COMMUNITY
SCHOOL CORPORATION
Office of the Superintendent
5805 E. Administration Road
Marengo, Indiana 47140
Telephone (812) 365-2135
Fax (812) 365-2783
Email *
Crawford County Community Schools Growing Toward Greatness
Name, First, Middle, Last *
Date *
MM
/
DD
/
YYYY
Position Desired: *
AN EQUAL OPPORTUNITYEMPLOYER The Crawford County Community School Corporation does not discriminate on the basis of age, race, color, religion, sex,marital status, handicap, disability, or national origin.IMPORTANT: Before final consideration for employment, the candidate must have on file in the office of the superintendent a complete set of transcripts and a placement file. It is the candidate/s responsibility to see that transcripts and placement files are provided. An interview is also required.All applicants must qualify for Indiana Certification prior to employment. *
Last Name *
Middle Name *
First Name *
Social Security Number
Present Mailing Address: Street *
Present Mailing Address: City *
Present Mailing Address: Zip *
Phone Number *
POSITION DESIRED: Elementary (Grades K-5) list in order of preference
POSITION DESIRED: Secondary (Grades 6-12) List subject area preferences
When would you be available to begin work? *
MM
/
DD
/
YYYY
Present Position *
Reason for leaving present position *
Present (or most recent) administrative supervisor(s): Please list NAME, BUSINESS PHONE, & HOME PHONE *
Have you ever been dismissed from a position? If yes, explain) *
Have you been asked to resign from a position? (Please check) *
Have you been asked to resign from a position? If yes, please explain *
Have you ever resigned rather than face disciplinary action and/or non renewal by an employer and/or disciplinary action against a license/certificate? (Please check) *
Have you ever resigned rather than face disciplinary action and/or non renewal by an employer and/or disciplinary action against a license/certificate? If yes, please explain
CERTIFICATION: Do you have a valid Indiana Certificate? *
Required
If YES, Kind of License(s)
Grade of License
Clear selection
License Serial Number, Date of Issue, and Date of Expiration:
Indiana State Teachers' Retirement Number (If applicable)
EDUCATIONAL PREPARATION: ("See resume" is not sufficient) PLEASE LIST NAME OF SCHOOL, DATES, DEGREE, GRADUATION DATE, AND TOTAL YEARS AT INSTITUTION *
Highest degree earned: *
Major Subject and Semester Hours
Minor Subject and Semester Hours
Do you plan to secure additional training? *
SUPERVISED TEACHING: PLEASE LIST THE NAME OF SCHOOL, THE SUPERVISING TEACHER, DATES, AND GRADE/SUBJECT TAUGHT
PROFESSIONAL EXPERIENCE: CONTRACTUAL TEACHING ONLY (SUBSTITUTE TEACHING DOES NOT COUNT) PLEASE LIST NAME OF SCHOOL, DATES, GRADE/SUBJECT, AND RASON FOR LEAVING
OTHER WORK EXPERIENCE: LIST EMPLOYER, LOCATION, NATURE OF WORK, AND DATES *
REFERENCES: PLEASE LIST NAME, YEARS KNOWN, OFFICIAL POSITION, ADDRESS, AND PHONE NUMBER *
REFERENCES: PLEASE LIST NAME, YEARS KNOWN, OFFICIAL POSITION, ADDRESS, AND PHONE NUMBER *
REFERENCES: PLEASE LIST NAME, YEARS KNOWN, OFFICIAL POSITION, ADDRESS, AND PHONE NUMBER *
REFERENCES: PLEASE LIST NAME, YEARS KNOWN, OFFICIAL POSITION, ADDRESS, AND PHONE NUMBER *
List any relatives now employed by the Crawford Community School Corporation:
MILITARY EXPERIENCE (if applicable) Branch of Service
MILITARY EXPERIENCE (if applicable) Dates Served
MILITARY EXPERIENCE (if applicable) Present Military Status
Write a brief statement indicating the reason why you desire to teach in the Crawford Community School Corporation, what plans you have for professional growth, and what your educational goals are for the future. *
Give a brief statement of your philosophy of education. Amplify any of your qualifications that you wish to stress. Present any additional information that you have not been able to include elsewhere on the application. *
CONVICTION REPORT: Because of the tremendous responsibility the Crawford County Community School Corporation has to its school children and community, my signature below constitutes authorization to check my employment history, including without limitation, evaluations, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any private or public employer or any state, local or federal agency. I further authorize those persons, agencies or entities that Crawford County Community School Corporation contacts in connection with my employment application to fully provide Crawford County Community School Corporation any information on the matters set forth above. Questions regarding this information should be directed to the Superintendent of Schools. Conviction of a crime is not an automatic bar to employment. The district will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position for which you are applying. Any false or misleading information on this application shall be fully sufficient grounds to refuse to employ or, having been employed, shall be immediate cause for dismissal. *CONVICTION means the final judgment on a verdict or a finding of guilty, a plea of guilty, or a plea of nolo contendere, in any state of federal court of competent jurisdiction in a case, regardless of whether an appeal is pending or could be taken. Conviction does not include a final judgment that has been expunged by pardon, reversed, set aside, or otherwise rendered invalid.Under penalty of perjury, I hereby affirm that the information presented on this application is true, accurate, and complete. I authorize the investigation of all statements contained herein and understand that agents of the Crawford County Community School Corporation may review any document relevant to this information. I authorize the Crawford County Community School Corporation to make reference checks prior to employment and I will execute such documents to facilitate this investigation. I understand that misrepresentation or omission of pertinent facts may be cause for dismissal.
I have read and accept this disclaimer. *
Signature: By entering your name in this box will be considered your official digital signature: *
Submit
Never submit passwords through Google Forms.
This form was created inside of Crawford County Community Schools. Report Abuse