Application for Employment Solomon USD #393 113 East 7 th Street Solomon, KS 67480 Phone: 785.655.2541 Fax: 785.655.2505 Personal Data Date: Name: Home Address: Present Address: Last First Middle Street / P.O. City State Zip Code Street / P.O. Box City State Zip Code Home Phone: Cell Phone: Email: Employment Preference Type of Application: Elementary Secondary Both: Type of Employment: Certified Classified: Administrative: Kind of Employment: Full Time Temporary or Part Time: Substitute: Academic and Professional Information High School Location Dates Attended Diploma College / University Location Dates Attended Diploma Undergraduate: Major Field: Sem. Hours: Minor Field: Sem. Hours: Graduate: Major Field: Sem. Hours: Minor Field: Sem. Hours: Total Semester Hours in Education: Total College Semester Hours: 1
Please describe any special strengths, talents, and/or unique qualities you possess which might be useful in your employment. 1. Do you now hold a valid Kansas Teaching Certificate: Yes No 2. Subject and grade levels in which you are qualified to teach: a) d) g) b) e) h) c) f) i) 3. Does your certificate qualify you to serve in Kansas in the position for which you are applying: Yes No 4. Are you currently under contract: Yes No 5. When will you be available for work: 6. If you are an applicant for an elementary position, do you have sufficient ability to teach art in your own classroom: Yes No 7. During the last twelve months, how many days of work have you missed? Practice Teaching - - Grade Level(s): Subject: School: Location: Supervisor: Phone Number of Supervisor: Email of Supervisor: --------------------------------------------------------------------------------------------------------------------------------------------------- Practice Teaching - - Grade Level(s): Subject: School: Location: Supervisor: Phone Number of Supervisor: Email of Supervisor: Professional Experience School District City State Assignment Dates 2
Other Work Experience Employer Address Position Dates Recommendations (Include principals, superintendents, supervising teachers. Include your last supervisor. Do not include relatives.) Name Address City Zip Code Phone # Position Professional Experience 1. List any extra-curricular activities which you are willing and qualified to direct: 2. List activities in which you participated in college, or sponsored in a previous district: 3. List any professional honors you have received: 4. List any professional and civic organizations in which you belong: 5. List any convictions for violations of the law other than minor traffic violations (If none, enter none): 6. List any positions from which you have been dismissed or forced to resign (If none, enter none): (Attach any explanation or information to number 5 and 6 if you feel that is appropriate) 3
Professional Questionnaire 1. What are your most important reasons for teaching or serving as a teacher/ administrator in USD #393? 2. In your opinion, what is the status of the education profession today? 3. What is one skill that every educator must have and please describe why? 4. If we were to ask your friends and co-workers, how would they describe you as a friend/fellow employee? 4
Additional Information Please send the following information by email to: Justin Coup-----jcoup@usd393.net Superintendent of Schools Unified School District USD #393 113 East 7 th Street Solomon, KS 67480 1. Completed Application (typed, typed preferred) 2. A copy of the applicant s college or university transcripts. 3. A copy of the applicant s valid teaching license. 4. A copy of the applicant s professional cover letter. 5. A copy of the applicant s professional resume. 6. A copy of the applicant s professional references. Include five references and a contact number for each. 7. Two professional reference letters. 8. Any additional information that you deem necessary. Before final consideration for employment, the candidate may be requested to submit evidence of eligibility for certification. I certify that all the information provided by me in this application is true and complete. I understand that any misstatement, falsification, omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination. I authorize any persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damages that may result from furnishing such information to you. I authorize any background checks by any third party. I authorize you to request, receive, and verify all information given on this application and I release you from all liability for any damages that may result from your doing so. I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete such investigation and I release you from all liability for any damages that may result from your doing so. Date: Signature of Applicant: Applications will be screened and candidates selected for interviews. Unified School District No. 393 Is An Equal Opportunity Educational Institution It is the policy of the Unified School District No. 393 to follow employment practices which consider only qualifications of the applicant for a position, without regard to race, religion, age, sex, or national origin. --------------------------------------------------------------------------------------------------------------------------------------------------- FOR USD 393 OFFICE STAFF ONLY Arrange Interview: Yes No Date and Time of Interview: Remarks for Interview: Employ: Yes No Date of Employment Salary Schedule Column/Step Hired by with Title: Date: 5