USD 459

BUCKLIN SCHOOLS BUCKLIN SCHOOLS

Certified Staff Application

Please complete form for consideration of employment. If you have any questions, please contact Emily Evans, BOE Clerk, at eevans@usd459.org or (620) 826-3828.

Unified School District #459 is an Equal Employment Opportunity Agency and does not discriminate on the basis of sex, color, race, religion, national origin, disability, or age, in admission or access to, or treatment or employment in, its programs or activities.

Certified Staff Application

Date of Application

Position Applying for

Last Name

First Name

Middle Initial

Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Phone Number

Current Employment Information

Employer

Employment Dates

Position

Salary

Extracurricular Duties

Reason for Leaving

Prior Employment Information

Employer

Employment Dates

Position

Extracurricular Duties

Reason for Leaving

Employer

Employment Dates

Position

Extracurricular Duties

Reason for Leaving

Employer

Employment Dates

Position

Extracurricular Duties

Reason for Leaving

Attach additional infomation, if needed.

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Educational Information

Please list your high school and college education in chronological order.

High School

Graduation Year

College

Location

Graduation Year

Degree and/or Hours

Major

Minor

Workshops or Seminars

College

Location

Graduation Year

Degree and/or Hours

Major

Minor

Workshops or Seminars

College

Location

Graduation Year

Degree and/or Hours

Major

Minor

Workshops or Seminars

Attach addition information, if needed.

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Certification Information

Are you currently certified in the state of Kansas?

Yes

If so, what kind of certificate?

When was your certificate issued?

When does your certification expire?

Professional honors and community activities:

Professional memberships revelant to position applied for:

Personal Information

Is there anything that may affect your ability to perform your duties as a teacher?

Yes

If yes, please explain:

Have you ever been convicted of a crime involving moral turpitude?

Yes

What is your educational philosophy?

Explain your thoughts as it relates to curriculum and instruction.

Briefly explain how you evaluate student performance.

What are your thoughts of integrating technology into classroom instruction?

If elected to this position, one of your responsibilities will be to be accountable for student performance. How would you do this?

State briefly your reasons for wishing to be an employee in our district.

Please mention here anything not included elsewhere in this application which you feel will further support your candidacy.

References

Please list three people who may be contacted to give current information on your qualifications to this position

Reference #1

Name

Position

Phone Number

Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Relationship

Years Known

Reference #2

Name

Position

Phone Number

Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Relationship

Years Known

Reference #3

Name

Position

Phone Number

Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Relationship

Years Known

Resume

Please upload current resume here.

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Acknowledgments

1. I certify that all the information provided by me in this application is true and complete. I understand that any mistatement, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination.

2. I authorize any of the 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.

3. I authorize you to request, receive, and verify all information given on this application and I release you from all damages that may result from your doing so.

4. 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.

Electronic Signature

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