2017 Summer School HEAD TEACHER Application
HEAD TEACHER APPLICATION
First Name
Your answer
Last Name
Your answer
Maiden Name
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Your answer
Email Address
Your answer
Are you currently or have you ever previously been employed by the School District of Janesville?
If yes, date of original hire
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Current and/or former School District of Janesville Positions?
Your answer
Current and/or former School District of Janesville schools worked at?
Head Teacher School Preference
Do you have a current and valid WI Teaching License?
If yes, do you have your current and valid WI Teaching License on file with the School District of Janesville Human Resources Department?
Indicate all grade levels/all subject areas in which you hold a Wisconsin License.
Your answer
Grade/Age Certified
Your answer
WI License Expiration Date
MM
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YYYY
Non-district applicants must submit a copy of his/her license to the Summer School Office.
Indicate present employment if other than School District of Janesville:
Your answer
Are you a U.S. Citizen
If not, are you eligible to work in the U.S.?
Have you ever been found guilty or do you presently have any pending violations of law other than minor traffic violations? (In accordance with state law, pending charges or convictions will not be used or considered unless they are substantially related to circumstances of the particular job)
If yes, please explain
Your answer
My electronic signature below authorizes the School District of Janesville to conduct a background investigation and authorizes release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal references, professional references, medical records, and other appropriate sources. I waive my right of access to any such information, and without limitation hereby release the school district and the reference source from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: the local Police Chief or Sheriff, information from the Central Criminal Records Exchange of either data on all criminal convictions or certification that no data on criminal convictions are maintained, information from the Wisconsin or other State Department of Social Services Child Protective Services Unit and any Locality to which they may refer for release of information pertaining to any findings of child abuse or neglect investigations involving me.
Furthermore, I certify that I have made true, correct, and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application, and I understand that any omission, false answered statement(s) made by me on this application, or any supplement to it will be sufficient grounds for failure to employ or for my discharge should I become employed with the school district.
Electronic Signature (Type your full first and last name)
Your answer
Today's Date
MM
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DD
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YYYY
By submitting an electronic signature, you certify that all information in your application is accurate and true
The Janesville Board of Education does not discriminate in employment on the basis of age, race, color, national origin, sex disability, creed, marital status, ancestry, arrest record or conviction records, sexual orientation, membership in the national guard, state defense force of any reserve component of the military forces of the United States or the State of Wisconsin, or any other basis protected by the law.
If you have questions concerning this application, please contact Paul Stengel at pstengel@janesville.k12.wi.us or contact the Summer School Office at (608) 743-5042.
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