Education and Training Instruction, Curriculum and Assessment Branch 1567 Dublin Avenue, Winnipeg, MB R3E 3J5 T 204-945-8806 or 1-800-282-8069 ext.8806 F 204-945-5060 E: ICAB@gov.mb.ca www.edu.gov.mb.ca/k12 Expression of Interest Form for Contracts with Education and Training This is a: New Application GENERAL Last Name: Given Name: Updated Application Mailing Address: City/Town: Postal Code: Email Address: Home Phone: Cell Phone: EDUCATION AND QUALIFICATIONS Name of College or University Location Attended from Year to Year Major / Minor Certificate / Diploma or Degree Attained TEACHING CERTIFICATE(S) Type Permanent Professional Certification MB Teaching Certificate Number Provisional Professional (expiry date: ) Prof. School Personnel Number (PSP) Special (expiry date: ) Permanent Special Vocational Number TEACHING EXPERIENCE School Division School Period of Employment Year to Year Full or Part-time (indicate %) Grades Taught Subjects Taught PREVIOUS EXPERIENCE WITH MANITOBA EDUCATION AND TRAINING Prior Contract Other: Development Team Member Page 1 of 5
TYPE OF CONTRACT: Place an x in the area(s) that you are interested in. 1. Independent Study Option Course Writer 7. Instruction and Curriculum Researcher 2. Independent Study Option Course Reviewer 8. Instruction & Curriculum Workshop Presenter 3. Independent Study Option Tutor/Marker 9. Instruction & Curriculum Writer and/or Resource Developer 4. Web-Based Course Writer 10. Instruction & Curriculum Reviewer 5. Web-Based Course Reviewer 11. Assessment- Provincial English Language Arts Test Texts Collector 6. Instruction and Curriculum Support Document Reviewer 12. Other SPECIALIST AREA: Place an x in the area(s) that you have recent (within the last five years) teaching, consulting, writing or leadership experience. Subject Area K - 4 5-8 9-12 Specify Subjects Applied Commerce (Formally Business Education and Marketing Education) Finance Strand Entrepreneurship Strand Commerce Strand Technologies, Topics and Trends Strand Sustainable Tourism Arts Education Dance Drama Music Visual Arts Career Development Cross-Curricular Reading is Thinking World Religions Computer English Language Arts English as an Additional Language English Language Arts Français/French Languages Other Than English or French American Sign Language Chinese (Mandarin) Cree Deutsch Filipino German Hebrew Italian Japanese Latin Ojibwe Polish Portuguese Spanish Ukrainian Other (please specify) Page 2 of 5
Subject Area K - 4 5-8 9-12 Specify Subjects Mathematics Essential Mathematics Introduction to Applied & Pre-Calculus Mathematics Applied Mathematics Pre-Calculus Mathematics Calculus/Advanced Mathematics Science General Biology Chemistry Physics Social Sciences Aboriginal Studies Home Economics/Human Ecology Physical Education/Health Education Psychology Social Studies Agriculture Geography History Canadian Law Technology Education/Industrial Arts Automotive Technology Carpentry Construction Design Drafting Electronics Technology/Electricity Graphic Communications Graphics Manufacturing Metalwork Power Energy Woodwork Special Language Credit Other (please specify) Subject Area Technology Education K-4 5-8 9-12 Technology Education High School Apprenticeship Technology Education Business Education and Marketing Education Technology Education Home Economics/Human Ecology Technology Education Technical Vocational Broadcast Media Technology/Electronic Communications Broadcast Media Technology/Radio and Television Broadcasting Cabinet and Furniture Making Page 3 of 5
Design Drafting Electronics Technology/Electronics Fashion Design and Technology Graphic Design/Advertising Art Interactive Digital Media Jewelry and Metalsmithing Microcomputer Systems Technician Networking and Cyber Security Photography Print Media Production Art Sound Engineering/Audio Recording: Production and Performance Aircraft Maintenance Technology Automotive Technology Aviation and Aerospace Technologies Baking and Pastry Arts Carpentry Child Care Collision Repair & Refinishing Technology/Auto Body Repair Culinary Arts Dental Assisting Dental Technology Electrical Trades Technology/Electricity Esthetics Nail Technology Esthetics Skin Care technology Exploration of Technical Vocational Education Hairstyling Health Care Assistant CVE Heavy Duty Equipment Technician Horticulture Hotel Hospitality CVE Industrial Electricity Machining Technology Mining Engineering Technology/Mineral Science Plumbing and Pipe Trades Refrigeration and Air Conditioning Resources and Environmental Management Sustainable Energy Welding Technology Technology Education/Industrial Arts Automotive Technology Design Drafting Electronics Technology/Electricity Graphic Communications Graphics Metalwork Woodwork Page 4 of 5
The Instruction, Curriculum and Assessment Branch is pleased to accept all expressions of interest. However, only those candidates selected for an interview will be contacted. Expression of Interest forms are kept on file for three years (please re-submit your form should updating of information be required or at the end of three years since the last submission). Date: Signature of Applicant: Freedom of Information and Protection of Privacy Act This personal information is being collected under the Authority of Manitoba Education and Training and will be used for the purpose of identifying potential contractors. It is protected by the Protection of Privacy provisions and the Freedom of Information and Protection of Privacy Act. If you have questions about the collection, contact Manitoba Education and Training Human Resources, 600 155 Carlton Street, Winnipeg, Manitoba R3C 3H8 Page 5 of 5