Application for Employment

APPLICATION FOR EMPLOYMENT

Brockton Public Schools
43 Crescent St. Brockton, MA 02301
Phone: (508) 580-7535
Fax: (508) 580-7091
Personal Information
Name *

First Name Middle Initial Last Name
Address

Street Address

Street Address Line 2

City State

ZIP
Previous Address (if less than three years at present address)
Phone Number *
Email Address
example@example.com
Alternate Phone Number
Employment Desired: (Check all that apply)

Certified Teaching Position Monitor Teacher Assistant (Bachelor’s Degree Required) Substitute Teacher (Min. 60 College Credits) Paraprofessional Administrative Assistant Food Service Custodian Substitute Monitor Teacher Assistant Substitute Paraprofessional Other
Other (Please Specify)
Grade Level/Subject Area Desired
Massachusetts DESE License # and subject area(s)
Are you legally authorized to work in the United States? *
Have you previously worked for Brockton Public Schools?
If yes, when?
Will you accept part time work?
Have you served in the Armed Forces?
Will you accept temporary work?
Do you have the ability to speak and write proficiently in a language other than English?
If so, what language(s)?
Please list any software applications with which you have had formal training or personal experience.
Education

Type of School

	Name	Location	Diploma/Degree
High School
Technical or Vocational
College/University
College/University

Are you working towards an advanced degree?
If yes, where?
How many semester credit hours do you have beyond your earned degree?
Work Experience- Please give a complete record of all employment starting with the most recent employment.

	(MM/YY)	(MM/YY)	Employer’s Name, Address, Telephone Number	Last Position Held	Reason for Leaving
JOB 1
JOB 2
JOB 3
JOB 4
JOB 5

Teaching Experience- Please list in chronological order. – Do NOT include Student Teaching.

	School	Location	Grade and/or Subjects	Name of Principal or Supervisor	(MM/YY)	(MM/YY)

Student Teaching Experience
School
Location
Grade and/or Subjects
Name of Principal or Supervisor
FROM (MM/YY)

Month Day Year
Date
TO (MM/YY)

Month Day Year
Date
Professional References

List below at least three (3) references, such as former employers who are familiar with your professional abilities. You may also list college references if applicable.

	Name	Position Held/Location	Telephone Number	Relationship

The Brockton Public School System does not discriminate on the basis of race, religion, color, national origin, age, sex, veteran’s status, sexual orientation, gender identity or disability in admission to, access to, treatment in or employment in its programs and activities.
Affidavit
I certify that the answers given by me on the foregoing questions and statements are true and correct without consequential omissions of any kind whatsoever. I agree that the Brockton Public Schools shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers or omissions made by me in this application. I authorize the companies, schools or persons named above to give any information regarding my employment. I hereby release said companies, schools or persons from all liability for any damage for issuing this information
Signature

Clear
Date

Month Day Year
Date
Should be Empty:

Personal Information

Education

Student Teaching Experience

Professional References

Affidavit