Teacher Application
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First Name *
Last Name *
Social Security No. *
Street Address *
City *
State *
Zip *
Email Address *
Cell Phone
Home Phone
Work Phone
Education: Institution; Location; Major; Degree; Year *
Duke: Durham, NC; Mechanical Engineering; BSE; 1993
2nd Degree? Institution; Location; Major; Degree; Year
3rd Degree? Institution; Location; Major; Degree; Year
Work Experience:  Employer; Location; Phone; Job Title; Supervisor; Dates (from/to) *
List paid and relevant volunteer experience, starting with most recent.  
Work Experience #2:  Employer; Location; Phone; Job Title; Supervisor; Dates (from/to)
Work Experience #3:  Employer; Location; Phone; Job Title; Supervisor; Dates (from/to)
Work Experience #4:  Employer; Location; Phone; Job Title; Supervisor; Dates (from/to)
Work Experience #5:  Employer; Location; Phone; Job Title; Supervisor; Dates (from/to)
Have you taught Adult Community Education previously? *
Required
If, yes. Where and what subjects?
What are you qualified to teach and interested in teaching in Community Education?  Please include your reasons for wanting to teach Adult Community Education. *
What other experiences, background and training do you have that may qualify you and be useful in teaching adults.  Please include biographical information we can share with prospective students.   *
May we release your contact information to prospective students? *
Personal Reference #1: Name, Position, Phone Number, Years Known *
Personal Reference #2: Name, Position, Phone Number, Years Known *
Personal Reference #3: Name, Position, Phone Number, Years Known *
I am seeking employment with the Livingston School District Adult Community Education Program.  I hereby authorize ACE to investigate my past employment and education, and to contact my references to discuss my professional qualifications for employment with Adult Community Education.   I hereby release the Livingston School District and any organization, company, institution or person furnishing information to the District and its agents as expressly authorized above, from any liability for damage which may result from any dissemination of the information requested, subject to the provisions of Title 44, Chapter 5, Part 3, MCA. *
Enter your name and the date to indicate your electronic signature
EOE
The Livingston School District is an Equal Opportunity Employer, and prohibits discrimination against or harassment of any person employed by or seeking employment with this program because of race, creed, religion, color, political affiliation or national origin, or because of age, physical or mental disability, marital status, or gender distinction.  People of disability may request reasonable accommodation in the hiring process by contacting the Adult Community Education Office.
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