Dierks Public School - Dierks Public Schools Certified Application

Certified Application

Applicant Information:

Last Name:

First Name:

Middle Name:

Address Information

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Phone Number:

Email Address:

Date Available:

Desired Salary: Min: 1 Max: 100000.00

Emergency Contact:

Emergency Contact Phone Number:

Position Desired (First Choice):

Position Desired (Second Choice):

Position Desired (Third Choice):

Educational and Professional Training

Name of High School

Date of Graduation:

Name of College:

Dates Attended:

Date of Graduation

Degree/Sem. Hours:

Additional Education:

Student Intern (if within the last five years)

Date:

School District:

Subject or Grade Level

Supervising Principal or Teacher:

College Professor who Supervised Internship:

Teaching Experience:

Name of School where you last taught:

Location:

Grade/Subject

Dates:

Number of Years:

List of Other Schools and Dates Taught:

References with contact information:

General Information:

Are you a citizen of the United States?

Yes

Have you been a member of the United States Armed Forces? Please indicate branch and length /dates of service.

Have you ever been convicted of a felony or misdemeanor:

Yes

If yes, then please explain.

Do you have a valid Arkansas Teachers License:

Yes

If so, please list the following information:

Type:

Certification Area:

Date Issued:

Date Expires:

Number:

Are you currently under contract with another school district?

Yes

If yes, when does contract expire:

To what professional organizations do you belong?

Are you on an Alternate Licensure Plan (ALP)?

Yes

Have you ever been on an ALP?

Yes

If yes, in which subject or grade area?

As a teacher, have you ever failed to have a contract renewed or been placed on probation?

Yes

If yes, please explain:

Have you ever had an ethics allegation or finding?

Yes

If yes, please explain

Explain why you chose to enter the field of education and describe your career goals in this profession:

Employment Application Checklist

Please submit required paperwork listed below:

Required paperwork:

Current teaching license and/or letter from Arkansas college stating all requirement completed for verification of initial licensure.

Verification of provisional licensure verification or Non_Traditional licensure verification.

Transcripts from colleges.

PRAXIS results (or other assessments relative to the position).

Resume (if desired).

List of references.

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The Dierks School District does not discriminate in employment on the basis of race, color, national origin, sex, or handicap.

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