Teacher Application

Teacher Application
SECTION I: PERSONAL INFORMATION
Name*

First NameMiddle NameLast Name
Maiden Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Social Security #
Date of Birth *

MonthDayYear
Date
Phone Number*
Email Address*
Permanent Address (If not same as above)
Which position are you applying for?*

TeacherParaprofessionalSubstitute TeacherBus DriverSubstitute DriverOther
Position

SECTION II: CERTIFICATION INFORMATION
List degrees and certifications*
Louisiana certificate number and type
Other valid state certification
National Board Certification*

YesNoCurrently awaiting scores
Highly Qualified?*

YesNo
What areas?

SECTION III: TEACHING EXPERIENCE
Teaching Experience 1:
Starting Date:
Ending Date:
Name of School:
Location:
Grade or Subject:
Supervisor/Principal Name, Address, Phone:
Do you have more work experience?*
Teaching Experience 2:
Starting Date:
Ending Date:
Name of School:
Location:
Grade or Subject:
Supervisor/Principal Name, Address, Phone:
Do you have more work experience?*
Teaching Experience 3:
Starting Date:
Ending Date:
Name of School:
Location:
Grade or Subject:
Supervisor/Principal Name, Address, Phone:

SECTION IV: EDUCATIONAL BACKGROUND
Educational Background 1:
Name and location of College or University and High School (Graduate and undergraduate - beginning with the most recent college experience):
Starting Date:
Ending Date:
Degrees Received:
Major:
Minor:
Do you have more educational background?*
Educational Background 2:
Name and location of College or University and High School (Graduate and undergraduate - beginning with the most recent college experience):
Starting Date:
Ending Date:
Degrees Received:
Major:
Minor:
Do you have more educational background?*
Educational Background 3:
Name and location of College or University and High School (Graduate and undergraduate - beginning with the most recent college experience):
Starting Date:
Ending Date:
Degrees Received:
Major:
Minor:
Do you have more educational background?*
Educational Background 4:
Name and location of College or University and High School (Graduate and undergraduate - beginning with the most recent college experience):
Starting Date:
Ending Date:
Degrees Received:
Major:
Minor:
Do you have more educational background?*
Educational Background 5:
Name and location of College or University and High School (Graduate and undergraduate - beginning with the most recent college experience):
Starting Date:
Ending Date:
Degrees Received:
Major:
Minor:

SECTION V: ADDITIONAL TRAINING AND PROFESSIONAL DEVELOPMENT
What, if any, computer programs are you skilled in?
What extracurricular activities do you have experience in sponsoring?
List any organizational memberships that you have that you feel are relevant to your ability to teaching.
Have you participated in any of the following professional developments?

Brain-Base LearningMountain MathAccelerated Reader/MathTeaching/Learning Styles (Gardner)LEAP remediation trainingOther
Have you participated in any faculty book studies? If so, name them.
List any school or parish wide committees that you have participated in or chaired.
List any educational awards, publications, or achievements.

SECTION VI: REFERENCES
Please list three references, other than the principal(s) and supervisor(s) previously listed and other than relatives, who can truthfully attest to your administrative ability, character, personality, scholarship, and work ethic. These people will be contacted.
Reference 1:
Name
Position
Relationship
Phone Number
Address
Reference 2:
Name
Position
Relationship
Phone Number
Address
Reference 3:
Name
Position
Relationship
Phone Number
Address
TO APPLICANT: All applications and accompanying records become the property of D'Arbonne Woods Charter School and are not available to candidates. Many people will not complete a reference unless confidentiality can be assured. I agree for this application to be confidential and by signing and dating the waiver and access below, I, the undersigned, waive any right of access to this reference.
Signature of applicant*

Clear
Date*

MonthDayYear

SECTION VII: GENERAL INFORMATION
Are you currently under contract? If so, where?
Have you ever been discharged, requested to resign, or refused tenure? Explain.
Are you retired from any Louisiana school district? Which system?
Have you ever been convicted of any felony or misdemeanor? If so, please explain.
Are you able to perform the duties (with or without reasonable accommodations) of the position for which you applying?
"I hereby certify that the information given in this application is true, accurate, and complete. I authorize D'Arbonne Woods Charter School, Inc. to investigate all statements made in this application. I understand that any misrepresentation, omission of facts, or falsification of facts shall be immediate justification for disqualification from employment consideration or termination, if employed. I herewith authorize D'Arbonne Woods Charter School, Inc. to request and receive confidential release of documentary materials relating to me, regardless of physical form or characteristics, prepared, owned, used, in the possession of, or retained by: (1) educational institutions I have attended, (2) previous employers of mine, and (3) city, parish, state, and federal law enforcement authorities. I understand that if D'Arbonne Woods Charter School, Inc. seeks to employ me that I will: (1) willingly consent to being fingerprinted and (2) give written permission for a criminal background investigation."
Print Name*
Date*

MonthDayYear
Signature*

Clear
D'Arbonne Woods Charter School, Inc. is an Equal Opportunity Employer and does not discriminate on the basis of age, gender, race, religion, handicapping conditions, or national origin in employment. This is in compliance with the Title VI, Title VII, Title IX, section 504, Americans with Disabilities Act (ADA),andallother applicable Civil Rights Laws.
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Teacher Application

SECTION I: PERSONAL INFORMATION

SECTION II: CERTIFICATION INFORMATION

SECTION III: TEACHING EXPERIENCE

Teaching Experience 1:

Teaching Experience 2:

Teaching Experience 3:

SECTION IV: EDUCATIONAL BACKGROUND

Educational Background 1:

Educational Background 2:

Educational Background 3:

Educational Background 4:

Educational Background 5:

SECTION V: ADDITIONAL TRAINING AND PROFESSIONAL DEVELOPMENT

SECTION VI: REFERENCES

Reference 1:

Reference 2:

Reference 3:

SECTION VII: GENERAL INFORMATION