Application for Professional Employment

Application for Professional Employment

The Hicksville Exempted Village School District is dedicated to the provision of equal educational opportunities and equal employment opportunities without regard to race, creed, economic status, national origin, sex or handicap.

Personal Data
Personal Data
Name

First NameLast Name
Present Address

Street Address

Street Address Line 2

CityState

Zip Code
Permanent Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Are you a U.S. Citizen?

YesNo

Certification
Certification

Please list all Licenses/Certifications you currently hold.*

	Type of Ohio Teaching License or Certification	Date Issued	Date of Expiration	Certificate Number	Subject or Grade Areas Appearing on the License/Certification
1
2
3
4
5

Please upload a copy of all valid Ohio Licenses/Certifications.

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Academic Preparation for Teaching
Academic Preparation for Teaching

Education*

	Name and Location	Dates Attended	Diploma or Degree	Total Semester Hours	Major	Minor	GPA	Distintion or Honors
High School
College or University
College or University
College or University
College or University

Total number of Under Graduate Semester Hours Earned
Total number of Graduate Semester Hours Earned
Semester Hours in Your Teaching Field(s)
Upload copies of Transcripts from each college you attended.

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Professional Experience
Professional Experience

Type a question

	School	Position	From	To	Total Years	Reason for Leaving
1
2
3
4
5

Are you presently under contract?

YesNo
To Whom are you under contract?
Why do you wish to leave?
Have you ever been employed under a continuing contract in Ohio?

YesNo
School System
Beginning Date

MonthDayYear
Date
Have you ever been discharged or requested to resign from a teaching position?

YesNo
Please Explain.
Have you ever applied for a position in the Hicksville Exempted Village School District?

YesNo

Other Work Experience
Other Work Experience

	Firm	Location	Kind of Work Performed	Dates of Service
1
2
3
4

List experiences you have had working with children (outside of school).
Home
Community
Camp
Other

Military
Military
Have you served in the military?

YesNo
List active service dates
Service Branch
Honorably Discharged   Yes   No
Rank at Discharge
Significant duties/honors

References
References

Please list at least THREE professional references.Experienced teachers MUST include the names of principals and/or superintendents under whom they have worked, including the most recent supervisor or administrator. Beginning teachers MUST include the name of the cooperating teacher. NOTE: If you have a current placement file, please request that it be sent to us.
Professional References
Name

First NameLast Name
Position or Occupation
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.
Reference Email
example@example.com
Name

First NameLast Name
Position or Occupation
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.
Reference Email
example@example.com
Name

First NameLast Name
Position or Occupation
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.
Reference Email
example@example.com
Personal References
Name

First NameLast Name
Position or Occupation
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.
Reference Email
example@example.com
Do we have permission to contact the above mentioned persons?

YesNo
Have you requested your placement file be sent to us?

YesNo

Professional Recognitions
Professional Recognitions
Briefly describe any professional recognition, memberships, and growth activities.
In the space below, please include any other pertinent data or information, not previously requested on the application, which might assist us in arriving at a more realistic appraisal of your training, experience, and overall competence for the position for which you are applying.

Educational Philosophy
Educational Philosophy
Please use the space below to express a portion of your educational philosophy.

Candidate's Statements
Candidate's Statements
I certify that all information on this application is true and complete to the best of my knowledge. I understand that any withholding or falsification of information on this application constitutes grounds for dismissal if I am employed. As an applicant with Hicksville Exempted Village Schools, I make the following commitments that I will abide by if employed:
1. I will respect other human beings regardless of race, sex, color, creed, handicap, or economic status.
2. As an educator, my highest priority will be service to students.
3. I will spend the time necessary to plan and organize for successful teaching.
4. I will spend time to attend and help supervise school activities and professional meetings outside of school hours.
5. I will assume additional duties to assure an efficient school operation such as hall duty, playground duty, etc.
6. I will continuously strive for better ways to help youngsters grow and learn through professional reading, further training, and participation in staff development activities.
7. I will take pride in my personal appearance and conduct to help ensure a proper image for students.
I agree that any claim or lawsuit relating to my service with the Hicksville Exempted Village School District must be filed, no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.
Signature

Clear
Date

MonthDayYear
Date

Authorization and Release for Disclosure of Information
Authorization and Release for Disclosure of Information
I hereby authorize the Hicksville Exempted Village Schools to obtain from my previous employer(s) all data necessary to support this application. In consideration of the disclosure and receipt of personal information necessary for full consideration of this employment application, I authorize the release of all high school, college, or other education records pertaining to my attendance, course work, and other school activities. I further consent to the disclosure of any and all information contained in private and governmental files relating to this employment application or relating to my present and former employment history. I authorize and request all former employers and federal, state, and local government agencies to release such information to Hicksville Exempted Village School District or its agent upon request. Hicksville Exempted Village School District is also authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies of their choice.

I release Hicksville Exempted Village Schools, its employees and agents, and all sources of information listed above from any and all legal liability arising from the release of the foregoing information to Hicksville Exempted Village Schools, or any other party with a proper and appropriate interest.
Signature

Clear
Date

MonthDayYear
Date

Statement of Job Applicant Regarding Criminal Record
Statement of Job Applicant Regarding Criminal Record

(O.R.C. 3319.39)
I, Enter Full Name , have not been convicted of, or entered a guilty plea to, any of the following offenses or any prior or existing laws of Ohio which are substantially similar or any prior or existing laws of another state or the federal government which are substantially similar.
Or

ANY FELONY, OR ANY OFFENSE OF VIOLENCE, THEFT OFFENSE,OR DRUG ABUSE OFFENSE, UNDER EITHER STATE LAW OR ANYSIMILAR MUNICIPAL ORDINANCE, THAT IS NOT A MINOR MISDEMEANOR.
Signature

Clear
Date

MonthDayYear
Date
If you cannot sign this form for any reason please write an explanation on a separate page or discuss directly with the hiring officer.
Have you ever been charged with one of the offenses listed above, and subsequently been convicted of, or pleaded guilty or no contest to, a lesser offense based on the same incident?

YesNo
Please Give Details
Have you ever been convicted of, or pleaded guilty or no contest to, an ATTEMPTED version of any of the offenses listed above?

YesNo
Please Give Details
Have you ever been subject to an investigation for child abuse conducted by a Children’s Services agency or a law enforcement agency?

YesNo
Please Give Details
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Application for Professional Employment

Personal Data

Teaching Preferences and Competencies

Certification

Academic Preparation for Teaching

Professional Experience

Other Work Experience

Military

References

Professional References

Personal References

Professional Recognitions

Educational Philosophy

Candidate's Statements

Authorization and Release for Disclosure of Information

Statement of Job Applicant Regarding Criminal Record