Application - Certified 2022

Certified Position Application

Crowley County School District Re-1-J
1001 Main Street
Ordway, CO 81063
Phone (719) 267-3117
Fax (719)267-3130

Applicants MUST be 21 or older to apply for certified positions.

If you need help to fill out the application form or during any phase of the application, interview, or employment process, please notify the district office and every reasonable effort will be made to accommodate your needs in a timely manner.
Position Applying for*
INSTRUCTIONS: Complete (please type or print) all sections accurately.
Name (Last, First, Middle *
Mailing Address*
City, State, Zip*
Email*
example@example.com
Phone Numbers: Home
Cell
Current job/employment*
Current Salary
If offered, date available to begin employment

MonthDayYear
Date
List any special skills or training that you have relating to the certified position for which you are
Have you ever worked for this school district in the past?

YesNo
If Yes: What Position
Date

MonthDayYear
Date
Reason for leaving

Prior Employment: Complete full information on last four employers. Start with most recent employer*

	From-to Month/Year	Employer's Name & Mailing Address	Supervisor's Name & Phone Number	Position & Duties	Reason for Leaving
Most recent employer
Employer #2
Employer #3
Employer #4

Education: Proof of education level may be required prior to employment.*

	Location	Number of Years Completed	Diplomas, certificates, etc
High School/GED
College
Other
Other

Each of the following questions must be answered with a "Yes" or "No." If any answer is "Yes," please attach an explanation, include final disposition of investigation. (Note: A "Yes" answer will not necessarily bar you from employment. Each situation will be judged with respect to time, circumstances, and seriousness
Have you ever resigned or been discharged from any position including the armed forces, while under suspicion of having engaged in criminal, immoral, unprofessional conduct, or are you under investigation for such a charge?*
Have you been convicted of a felony or misdemeanor. Including pleading nolo contender, or are you under investigation for any such offense, other than a minor traffic offense? Please note: Driving While Intoxicated (DWI), Driving Under the Influence (DUI), and similar charges are NOT considered minor traffic offenses.*
Have you ever surrendered a certificate, credential/license/permit or have one denied, revoked, or suspended in lieu of dismissal?*
Have you ever received an unsatisfactory performance evaluation?*
Have you ever received probation or deferred judgment?*
Have you ever served time in prison?*
Have you ever been convicted, resigned, discharged from any position in which the subject of the investigation involved criminal, immoral, or unprofessional conduct with/involving children in which you were in a position of trust?*
I am aware that if offered a position, a background check will be made on behalf of the school district.*

References: Give the names of three persons who have supervised you or who know about your work experiences and are not related to you.*

	Name	Full Mailing Address	Position	Phone Number (with area code)	Work
Ref #1
Ref #2
Ref #3

Have you been given a job description or had the essential requirements of the job explained to*

[ ] Yes[ ] No
Do you understand these requirements?*

[ ] Yes[ ] No
Can you perform the essential requirements of this job with or without reasonable accommodation?*

YesNo

I am aware that it is my responsibility to have a teacher's certificate from the Colorado Department of Education to become a highly qualified teacher. It is the responsibility of the applicant to have all records, transcripts, certificates, license and other documentation completed to complete the hiring process, if offered a contract.*

[Yes ]No
I hereby certify that all statements made on this application are true, accurate, and complete. Any misrepresentations or willful omissions of facts shall be sufficient cause for the disqualification of the application or termination from employment. I hereby authorize the district or its agents to conduct work history and personal reference checks to verify statements on this application form and other materials provided as part of my application for this position. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated at any time without previous notice.
Signature*

Clear
Date*

MonthDayYear
Date
Upload resumes, certifications, continuing education, etc.

Cancelof
Crowley County RE 1-J School District does not discriminate on the bases of race, color, national origin, sex, or disability in its programs or activities. The following Person has been designated to handle inquiries regarding the nondiscrimination policies and grievance procedures:

Superintendent of Schools - Juan Ramirez 1001 Main Street Ordway, CO 81063 (719)267-3117 Scott.cuckow@cckl2.net
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Certified Position Application