North Knox Certified Job Application

Certified Job Application

Please complete the form below to apply for a teaching position with North Knox
Full Name*

First NameMiddle NameLast Name/Maiden
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Email Address*
example@example.com

Certification

Type of Indiana License or Certification

	Type of Indiana License/Certificate	Prov/Grade Permanent	Grade/Subjects Covered	Date of Issue	Date of Expiration
Certification 1
Certification 2

If you do not have an Indiana Certificate, have you applied for one?*

YesNo

License or Certification Held in Another State

	Type of License/Certificate	Prov/Grade Permanent	Grade/Subjects Covered	Date of Issue	Date of Expiration
Certification 1
Certification 2

SSN
Indiana Teacher Retirement #

Professional Preparation

	School Name, City, State	Dates Attended	Hours of Credit	Degree Earned/Major
High School
College/University
College/University
College/University

List Minor(s)
Total # of Hours Beyond Bachelor's Degree
Master's Degree

Military Service

	Branch of Service	Dates	Type of Discharge	Total Military Time of Service
.

Teaching/Other Work Experience

	Name/Address of School	Dates	Reason for Leaving	Immediate Supervisor
1
2
3
4

Summary of Years of Regular Teaching Experience

	Elementary	Jr/Sr HS	College	Total
.

Other Work Experience

	Name/Address of Employer	Dates	Type of Position	Immediate Supervisor and Phone Number
1
2
3
4

References

	Name	Address	Occupation
1
2
3
4

Please List any Hobbies or Special Interests

Address All Communications To:

North Knox School Corporation

11110 N. SR 159

Bicknell, IN 47512
College Transcripts

Cancelof
Indiana Teacher's License

Cancelof
Resume

Cancelof
Letter of Reference

Cancelof
Letter of Reference

Cancelof
North Knox School Corporation has a policy of providing equal opportunity. All courses are open to all students regardless of race, color, sex, handicapping conditions, or national origin including limited English proficiency.

Educational services, programs, instruction, and facilities will not be denied to anyone in the North Knox School Corporation as the result of his or her race, color, sex, handicapping conditions, or national origin including limited English proficiency. For further information, clarification, or complain, please contact the following person: Mr. Matt Sandefer, Title IX Coord., North Knox High School, 10890 N. SR 159, Bicknell, IN 47512, (812) 735-2990.

Any other information concerning the above policies may be obtained by contacting: Dr. Darrel Bobe, Superintendent, Section 504 (handicapped) & Americans with Disabilities Coord., North Knox School Corporation, 11110 N. SR 159, Bicknell, IN 47512, (812) 735-4434.
I authorize investigation of all the statements in this application, including investigation of previous employment experiences if I am considered for employment. I certify that the above answers are true and complete and understand that falsification of facts on this application shall be considered sufficient cause for disqualification or dismissal. References and personal information which become part of this record are to be regarded as confidential and will not be revealed.
Signature*

Clear
Should be Empty:

Certified Job Application

Teaching Areas and Preferences

Certification

Professional Preparation

Teaching/Other Work Experience

North Knox School Corporation Request for Background Information