OFFICIAL APPLICATION
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Phone:
(731) 742-3180
Fax:
(731) 742-3994
Website:
bradfordssd.com |
Dan Black, Director of Schools |
For office use only:
______________
Date Reviewed
______________
Date of Interview
Date of Employment
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Date:
Name:
(Last)
(First)
(Middle)
(Social Security Number)
__________________________________________________
Address:
Street
City
State
Zip
Telephone Number:
Cell Phone:
Check grade and/or subjects for which you are applying. Indicate only areas for
which you are, or will be certified.
Pre-K
Kg
1-3
4-6
Secondary 7-12 (List Subjects)
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Library
Special Education
Other
Athletic Coaching (List Sports)
Extra Curricular Areas Desired
PROFESSIONAL PREPARATION
A. Educational Preparation (Complete
all applicable items.)
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School |
Name and Location |
Dates
Attended |
Major |
Minor |
Degree
Awarded |
Month |
Year |
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High School
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College/Univ.
BS/BA
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College/Univ.
MS/MA
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Hours beyond
MS/MA
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B. Practice Teaching
(If teaching less than five years)
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Name of School |
School System |
Dates |
Hours Per Day |
Grade Levels |
Subject |
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C. Praxis Scores:
Communications _____
General Knowledge ______ Professional Knowledge _____
Date taken: ______________
Specialty Area:
__________________________ Score: _____
PROFESSIONAL EXPERIENCE
List only the kinds of experience recognized by the State Department of
Education for salary purposes.
Attach additional page if necessary.
A.
Full Time teaching experience (K-12).
List all contractual work.
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No. of
Years/Months |
Dates |
Name of
School System |
State |
School |
Grade(s) |
Subjects |
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B.
Active military service
Number of years______________ Dates_________________ Branch of
Service____________________________
C.
List other work experiences which are not described in the above categories.
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Dates |
Company/Service |
Location |
Type of Work |
Phone Number |
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CERTIFICATION
A.
Professional Certificate No.
Exp. Date
Areas of Certification
Areas Highly Qualified
Other types of certificate issues
Certificate No.
Exp. Date
Areas of Certification
Other States
Type/No.
Area
of Certification
All applications will be placed in a selection pool based on the
completion of the following requirements.
1.
A complete professional staff application form supplied by the
2.
Photo copy of praxis scores (core and specialty area).
3.
Photo copy of college transcript showing degree granted.
4.
Photo copy of certificate.
5.
Resume of work experience.
SKILLS, ACTIVITIES, CLUBS
A. List any activities in which you have participated or club you have sponsored
during previous employment.
(Academic and/or athletic)
______
______
______
B. List the clubs and/or activities you are willing to sponsor (including
coaching responsibilities). (Grades 7-12)
________________________________________________________________
C. List the special skills and/or abilities that you can contribute to our
school system
________________________________________________________________
D. Briefly describe your philosophy of education.
______
Application must be completed and signed before application is active.
THE
STATE REGULATIONS REQUIRE THAT THIS SECTION BE COMPLETED BEFORE APPLICATION IS
ACTIVE.
I hereby apply for employment as
in the named school system beginning
I recognize that, if I am employed, the board of education of the said school
system will assign or reassign me to a specific position as the need requires.
I hereby certify that I (
) have / (
) have not been convicted of a misdemeanor or a felony in any state
of the
If “HAVE” is indicated, explain fully the details of each such conviction on a
separate sheet of paper.
I further certify that I (
) have / (
) have not been dismissed from any previous employment for improper
or unprofessional conduct, inefficient service, neglect of duty, incompetence or
insubordination as the same are defined in Section 49-5-501 of the Tennessee
Code Annotated.
If “HAVE” is indicated, explain the details of each such dismissal on a separate
sheet of paper.
The employer’s non-renewal of yearly contract need not be indicated unless the
non-renewal was for cause as listed above.
If my most recent employer was another
I understand that misrepresentation of any of these certifications may subject
me to the applicable penalties in Section 49 of the Tennessee Code Annotated.
Date
Signature
__________________
City
State
Zip
REFERENCES (Complete
name, address and Zip code information must be furnished)
Name
Address
Zip
Occupation
Phone No.
Professional
_______
_____________________________________________________________________________________________________________________________________________________________________
Professional
________________________________________________________________
______________________________________________________________________________________
Professional
________________________________________________________________
_____________________________________________________________________________________
VALIDATION: To the best of my
knowledge, all information on this form is complete and accurate
Signature
Date
Because of the volume of applications received, further contact with applicants
following the personal interview will not be made unless the applicant is being
considered for a specific position.