MSAD
#37
Office of the Superintendent
PO Box 79~~Harrington, Maine 04643
Telephone (207) 483-2734~~Fax: (207) 483-6051
APPLICATION
FOR TEACHING POSITION
MSAD #37 does not
discriminate in the operation of its educational and employment policies and will honor all appropriate laws relative to discrimination.
Date _______________________Position applying for: (grade level, subject,
other)________________
Name
________________________________________________________________________
Social Security Number
__________________________________________________________
When will you be
available? ____________________________
Permanent Address ____________________________________ Phone ___________________
Temporary Address
___________________________________ Phone ___________________
EDUCATION: Transcripts or copies of
official transcripts of all college/university grades must be provided.
It is essential
that this section be completed accurately.
|
No. of Yrs. Colleges/Universities
Attended |
Degree Awarded (if any) |
Attended |
Grade Point Average |
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Number of semester
hours in:
(Hours) (Hours) (Subject)
_________________ Reading ______________
Major (__________________________________)
_________________ Math ______________ __Minor
(__________________________________)
_________________ Special Education
__________ Major (_______________________________)
CERTIFICATION: List certification(s) you
hold and provide copies of certification.
Type State Date Issued Date of Expiration
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Have you taken the
National Teacher’s Exam? ___________ If
yes, please include a copy of your test results..
If you do not hold a Maine certificate, for what type of Maine certificate(s) are you applying and eligible?
______________________________________________________________________________
Note:
Candidates who do not hold Maine certification should direct an inquiry to the
Maine Department of Education, Division of Certification and Placement,
Augusta, Maine 04333.
Are you retired from the Maine State
Retirement System? YES _______ NO _______
EXPERIENCE: Number of years of teaching
experience _____________
If none, student teaching ___________________ substituting
_________________________
A resume must be provided. In addition to educational
background and work experience, please include extracurricular activities in
which you have been involved. Please list below positions held, employer and
dates of employment for the past ten years. Please account for any gaps in
employment on a separate page.
|
From (month/year) |
To (month/year) |
Position |
Employer |
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
On a separate sheet, please describe a specific class or class activity
you planned and actually conducted which illustrates your philosophy of
teaching and is the best example of your teaching skill. What evidence showed
you that his class or activity was successful in terms of student motivation
and achievement?
BACKGROUND: If you answer YES to any of the following
questions, please provide full details on an additional sheet including, with
respect to court actions, the date, offense in question, and the address of the
court involved. Conviction of a crime is not an automatic bar to employment.
Have you ever been disciplined, discharged, asked to resign, or
failed to receive a continuing contract appointment from a prior position?
Yes _______ No _________
Have you ever resigned from a prior position after a complaint
had been received against you or your conduct was under investigation or
review?
Yes ______ No _______
Has your contract in a prior position ever been non-renewed?
Yes _______ No ________
Have you ever not been nominated for re-employment in a prior
position or ever had your nomination for re-employment not be approved?
Yes _______ No _________
Have you ever been charged with or investigated for sexual abuse
or harassment of another person?
Yes _______ No _________
Have you ever been convicted of a crime (other than a minor
traffic offense)?
Yes _______ No _________
Have you ever entered a plea of guilty or "no contest"
(nolo contendere) to any crime (other than a minor traffic offense)?
Yes _______ No _________
Have you ever had a professional license or certificate
suspended or revoked in any state, or have you ever voluntarily surrendered,
temporarily or permanently, a professional license or certificate in any state?
Yes _______ No _________
Has any court ever deferred, filed or dismissed proceedings
without a finding of guilty and required that you pay a fine, penalty or court
costs and/or imposed a requirement as to your behavior or conduct for a period
of time in connection with any crime (other than a minor traffic offense)?
Yes _______ No _________
REFERENCES: List three, two of whom are most recent supervisors, who can comment on
your ability and whom we may contact. In addition, please provide three letters
of reference from persons who are not related to you (may be from references
listed below).
Name Position Address Phone
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
My signature below constitutes authorization to check my employment
history, including without limitation, criminal arrest and conviction record
checks, reference checks, and release of investigatory information possessed by
any state, local or federal agency. I further authorize those persons, agencies
or entities that MSAD #37 contacts in connection with my employment application
to fully provide MSAD #37 any information on the matters set forth above. I
expressly waive in connection with any request for or provision of such
information, any claims, including without limitation, defamation, emotional
distress, invasion of privacy, or interference with contractual relations that
I might otherwise have against MSAD #37, its agents and officials or against
any provider of such information.
I understand that information submitted in and with this application
may be disclosed to a screening and/or interviewing committee, which may
include board members, administrators, other staff, and members of the
community. I give my consent to this disclosure.
Signature _____________________________Driver’s License #
___________________
Date __________________
Application Check list: The completed employment application cannot be
evaluated unless all of the following materials have been provided:
_______ Application form fully completed and signed
_______ Copies of Transcripts
_______ Copy of Certification
_______ National Teacher’s Exam results (if applicable)
_______ Resume
_______ Gaps in employment during the past ten years explained
_______ Illustration of your philosophy of teaching
_______ YES to any of the questions in the Background section explained
_______ Three letters of reference
Applications
will remain active for a period of 12 months from date of receipt. All
materials become the property of MSAD #37. None will be returned. Any
falsification of information or misleading information on this application
shall be fully sufficient grounds to refuse to employ or, having been employed,
shall be immediate cause for dismissal.
Revised: March, 2002