APPLICATION FOR CERTIFIED POSITION

CROSS COUNTY SCHOOL DISTRICT NO. 7

21 CR 215, CHERRY VALLEY, ARKANSAS 72324

APPLICATION FOR CERTIFIED POSITION
1. PERSONAL
(The information requested must be submitted on this application form. A resume or additional information may be attached as a supplement but may not be submitted in lieu of fully completing this application A completed application will remain on active file for a period of one year and may be renewed by reapplying or by a letter of request.)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Mobile Phone Number
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Position Desired
Grade
Subject
Do you hold a certificate valid in this state?

YesNo
If yes, what type is it?
Date of issue

MonthDayYear
Date
Certificate Number
Expiration Date

MonthDayYear
Date
If applicant does not have a valid certificate, has certificate been applied for?

YesNo
Areas of Certification
Approval Areas
With what community organizations are you associated?
In what recreations for you engage? Outdoor:
Indoor
Have you had experience sponsoring extra-curricular activities?

YesNo
If yes, which ones?

V. REFERENCES

Please list references, including especially superintendents and principals under whom you have taught, who have first-hand knowledge of your character, personality, scholarship and teaching ability.
Name
Address
Phone Number
Please enter a valid phone number.
Official Position
Name
Address
Phone Number
Please enter a valid phone number.
Official Position
Name
Address
Phone Number
Please enter a valid phone number.
Official Position
Name
Address
Phone Number
Please enter a valid phone number.
Official Position
Why do you feel you are qualified for the position for which you are applying?
Additional Remarks
PLEASE READ CAREFULLY BEFORE SIGNING

My signature below authorizes the school district to conduct a background investigation and authorizes release of information in connection with my application for employment. The investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal references, professional references, and other sources deemed appropriate in the sole discretion of the school district. I waive my right of access to any such information, and without limitation hereby release the school district and the reference source from any liability in connection with its release or use. This release includes the sources cited above and illustrative examples as follows: the local sheriff, information from the Central Criminal Records Exchange of either data on all criminal convictions or certification that no data on criminal convictions are maintained, information from the Arkansas or other State Department or Social Services Child Protective Services Unit and any Locality to which they may refer for release of information pertaining to any findings of child abuse or neglect investigations involving me.

Furthermore, I unconditionally certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application. I acknowledge that these questions shall be continuing in nature, and I have a duty to update, change or further amplify my answers to guarantee accuracy at all times. I understand that any omission, misleading or falsely answered statements made or implied by me on this application, or any supplement to it, whether written or oral, will be sufficient grounds for failure to employ or for my immediate discharge should I become employed with the school district. In the event the School Board determines, in its sole discretion, the existence of a material adverse report or omission as to any information, I agree that the employment offer/appointment will be deemed revoked immediately without further action, notice, or process. In conclusion, I acknowledge that if accepted for employment, I hereby agree to abide by the policies, regulations, and directives of the school district.
Signature of Applicant

Clear
Optional: Resume

Cancelof
The Cross County School District is an equal opportunity education institution. The law protects the rights of an equal employment opportunity regardless of race, religious creed, national origin, ancestry, physical handicap, sex or age.
Should be Empty:

CROSS COUNTY SCHOOL DISTRICT NO. 7

21 CR 215, CHERRY VALLEY, ARKANSAS 72324

APPLICATION FOR CERTIFIED POSITION

II. EDUCATION AND PROFESSIONAL TRAINING

III. Employment History

IV. GENERAL FACTS