Certified Employment Application Form

Certified Employment Application Form:
Personal Information:
Date*

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Permanent Phone Number*

Area CodePhone Number
E-mail
Present Position*
Applying for*
College attended from most recent

	Name	Dates Attended	Major	Minor	Degree
1
2
3

High School Diploma earned at
Name of High School Attended
Extra-curricular activities in high school and college
Teaching Experience from most recent:
School Corporation
Number of Years Taught
Dates
Grade or Subject Taught
Principal's Name
School Corporation
Number of Years Taught
Dates
Grade or Subject Taught
Principal's Name
School Corporation
Number of Years Taught
Dates
Grade or Subject Taught
Principal's Name
Skills/Qualifications:
Extra-curricular activities which you feel qualified to direct:
Indiana License Number
Subject Area(s)
Date License Expires
Professional Memberships:
References:
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 1 Address
Official Position
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2 Address
Official Position
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 3 Address
Official Position
Cover Letter & Resume (Optional):
Cover Letter

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Resume

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Please write any comments which might assist us in evaluating your potential as a prospective Tri-County Teacher.
Send Application:
By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
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Certified Employment Application Form:

Personal Information:

College attended from most recent

Teaching Experience from most recent:

Skills/Qualifications:

References:

Cover Letter & Resume (Optional):

Send Application: