Certificated Application
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ABCDEFGHIJ
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APPLICATION
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AN APPLICATION FOR A CERTIFICATED POSITION IN THE
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Cambridge School District #432
Phone: 208-257-3321
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40 North 4th Street
Fax: 208-257-3323
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PO Box 39
www.cambridge432.org
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Cambridge, ID 83610
clakey@cambridge432.org
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Name: email:
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(last) (first)(middle)
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Current Address:
Phone:
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Permanent Address:
Phone:
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Use Current Address Until this Date:
Cell #:
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Primary position for which you are applying:
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Other positions for which you are qualified:
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If you have a valid Idaho Teaching Certificate complete the following:
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Type of Certificate:
Expiration Date:
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Endorsement(s):
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If you do not have a valid Idaho Teaching Certificate, explain plans for obtaining one:
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Have you ever had a teaching certificate suspended or revoked?
NoYes
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If Yes, please explain:
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Have you ever been convicted of a felony?
NoYes
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If Yes, please attach a brief explanation.
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EDUCATIONAL TRAINING (list in order of attendance starting with most recent)
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DateDateDegree Date of# of
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College/University
LocationFromToEarnedDegreeMajorMinorCredits
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TEACHING AND JOB-RELATED EXPERIENCE
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List more recent experience first--include military if assignment was teaching or instruction.
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Employer
Superintendent or
Supervisor
DateDate
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Name
Supervisor
Phone #
FromTo
Position Held
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EXTRA-CURRICULAR ACTIVITIES
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(Mark applicable columns with "X")
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Name of School or
Directed/
Qualified/Able
DateDate
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Name of Activity
Organization
Coached
Assisted
to Direct or Coach
FromTo
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REFERENCES
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Name
Title
Address
Phone #
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I hereby certify that the information herein is a true and complete statement of my personal/professional
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record to date.
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Signature:
Date:
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Cambridge School District #432 is an Equal Opportunity/Affirmative Action Employer
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