Employment Application Form

Employment Application Form

Apply to join our teaching and coaching team
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth (Optional)

MonthDayYear
Social Security Number (Optional)
Education
High School - City/State*
Graduation Year*
College/University - City/State
Graduation Year
Degree

AssociatesBachelor'sMaster'sOther
Minors/Majors - GPA
Would you like to add a second degree?

YesNo
College/University - City/State
Graduation Year
Degree

AssociatesBachelor'sMaster'sOther
Minors/Majors - GPA
Would you like to add a third degree?

YesNo
College/University - City/State
Graduation Year
Degree

AssociatesBachelor'sMaster'sOther
Minors/Majors - GPA
Desired Positions that apply)*

TeacherAdministrationCoachTeaching AssistantCafeteria WorkerCustodianSubstitute TeacherBus DriverOther
Desired Administrative Position(s)*

SuperintendentDirector of Curriculum and InstructionJSHS PrincipalJSHS Assistant PrincipalElementary PrincipalElementary Assistant PrincipalAthletic Director/Director of TransportationDirector of LiteracyDirector of Integration
Level of Teaching? (Click all that apply)*

Elementary K-6Junior High 7-8High School 9-12
Interest in what content areas to teach?*
Do you currently hold a valid Indiana Teaching License*

YesNo
List your licensed content areas?*
Please upload copy of license at the end of the form.
Teaching Experience Years in Education*

0-2 Years3-5 Years5-10 Years11-20 Years20-30 Years30+
Administrative Experience Years in Education*

0-2 Years3-5 Years5-10 Years11-20 Years20-30 Years30+
Student Teaching Experience

Within the last three school years, please complete
School Building(s)*
School Corporation(s) (City/State)*
Administrator(s)*
Grade(s)/Subject(s)*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Supervising Teacher(s)*
Administration Experience

Most recent first, please
School Corporation*
School Building*
Supervisor Name*
Position Held*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 2nd Administrative Experience?*

YesNo
School Corporation*
School Building*
Supervisor Name*
Position Held*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 3rd Administrative Experience?*

YesNo
School Corporation*
School Building*
Supervisor Name*
Position Held*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
Teaching Experience

Most recent first, please
School Corporation*
School Building*
Supervisor Name*
Grade(s)/Subject(s)*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 2nd Teaching Experience?*

YesNo
School Corporation*
School Building*
Supervisor Name*
Grade(s)/Subject(s)*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 3rd Teaching Experience?*

YesNo
School Corporation*
School Building*
Supervisor Name*
Grade(s)/Subject(s)*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 4th Teaching Experience?*

YesNo
School Corporation*
School Building*
Supervisor Name*
Grade(s)/Subject(s)*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 5th Teaching Experience?*

YesNo
School Corporation*
School Building*
Supervisor Name*
Grade(s)/Subject(s)*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Address*
Telephone number*
May we contact?*

YesNo
Reason for leaving*
U.S. Military Experience?*

YesNo
Branch of Service*
Technical Specialization
Rank Attained*
Years of Service*
Coaching Interest
Interest in coaching Boys and/or Girls - What Sport(s) and What Level(s)*
Coaching Experience
School Corporation/Program*
School Building/Location*
Supervisor Name*
Telephone number*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Teams/Level/Years coached*
Championships/Awards*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 2nd Coaching Experience?*

YesNo
School Corporation/Program*
School Building/Location*
Supervisor Name*
Telephone number*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Teams/Level/Years coached*
Championships/Awards*
May we contact?*

YesNo
Reason for leaving*
Would you like to add a 3rd Coaching Experience?*

YesNo
School Corporation/Program*
School Building/Location*
Supervisor Name*
Telephone number*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Teams/Level/Years coached*
Championships/Awards*
May we contact?*

YesNo
Reason for leaving*
Other Relevant Coaching Experiences*
Work Experience - Non-Certified
Position*
Employer*
Supervisor Name*
Telephone number*
Address*
May we contact?*

YesNo
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Reason for leaving*
Do you have a CDL?*

YesNo
Types of CDL licenses or certifcations? Choose all that apply.

Class AClass BClass CPassenger Endorsement (P)School Bus Endorsement (S)Tank vehicle endorsement (N)Hazardous materials endorsement (H)Tanker/HazMat combination endorsement (X)Doubles/triples endorsement (T)
Would you like to add a 2nd Work Experience?*

YesNo
Work Experience - Non-Certified 2
Position*
Employer*
Supervisor Name*
Telephone number*
Address*
May we contact?*

YesNo
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Reason for leaving*
Would you like to add a 3rd Work Experience?*

YesNo
Work Experience - Non-Certified 3
Position*
Employer*
Supervisor Name*
Telephone number*
Address*
May we contact?*

YesNo
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Reason for leaving*
References

Please list three (3) individuals we may contact who know your background and qualifications. Do not list relatives.
Name*
Relationship*
Address*
Telephone number*
Name*
Relationship*
Address*
Telephone number*
Name*
Relationship*
Address*
Telephone number*
Other Relevant Work Experiences*
Availability
Date when you would be available to work?*

MonthDayYear
Are you at least 18 years of age?*

YesNo
Please list the type of work you are looking for:*

Full TimePart timeSubstitute
Please list any days/shifts that you would be unable to work?*
Are you related to anyone in the employ of North Daviess Community Schools?*

YesNo
If yes, please list name, title, and school location:*
Criminal Record
Have you ever been convicted of a felony?*

YesNo
If you answered yes to the above question, please explain:*
With respect to your present or most recent employer, did you or have you offered a resignation from thatposition?*

YesNo
With respect to that employer, were you ever considered for discipline or discharge due to your alleged conduct or misconduct? If yes, please explain the circumstances on a separate sheet and attach to this application.*

YesNo
Have you ever been reprimanded, disciplined, discharged, or asked to resign from a prior position?*

YesNo
Have you ever resigned from a prior position without being asked, but under circumstances involving youremployer’s investigation of sexual contact with another person, of mishandling funds, or of criminal conduct? Ifyes, explain the circumstances on a separate sheet and attach to this application.*

YesNo
Have you ever been charged with or investigated for sexual abuse of another person?*

YesNo
Have you (a) ever been convicted of a crime, other than a minor traffic offense; or (b) ever entered a plea of guilty or a plea of “no contest” (nolo contendere), or has any court ever deferred further proceedings without entering a finding of guilty and placed you on probation, for any crime other than a minor traffic offense?*

YesNo
Have you ever been charged with, pleaded guilty or “no contest” (nolo contendere) to, or been convicted of anycrime involving sexual abuse of any person or any other crime of moral turpitude? (Moral turpitude is an act ofbaseness, vileness, or depravity in the private and social duties which a person owes another member of society or society in general and which are contrary to the accepted rule of right and duty between persons, including, butnot limited to theft, attempted theft, murder, rape, swindling and indecency with a minor.)*

YesNo
If you have answered yes to any one of the previous three questions, please explain, in detail, including the date of the charge, the court action, the offense in question, and the address of the court involved.*
Upload Resume or Supporting Documents

Cancelof
North Daviess Community Schools does not discriminate on the basis of race, creed, color, sex, religion, national or ethnic origin, age, or disability. I hereby certify that the information found within this application has been provided voluntarily and I waive any right to assert discrimination on the basis of that which has been divulged. I hereby authorize all persons, firms, corporations, educational institutions, and organizations of any kind to release to the North Daviess Community School Corporation any and all information, files or records pertaining to application, and to permit inspections, and to furnish copies of any documents pertinent to this application. I further authorize any and all persons in any capacity to answer any and all questions in any form that may be submitted to them concerning this application. I understand that my application will remain in the Central Office files for one (1) year, and all materials accompanying this application will become the property of North Daviess Community Schools. I certify there are no misrepresentations in or falsifications of these statements and answers. I am aware that should investigations disclose such, my application may be disqualified, my name removed from all eligible lists, and my future applications may not be accepted. I am also aware that falsification of this application, or any accompanying data, may result in my dismissal from any position with North Daviess Community Schools. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the North Daviess Community School Corporation. I expressly waive in connection with any request for or provision of such information, any claims, including without limitations, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the North Daviess Community School Corporation, its agents and officials or against any provider of such information. Signature of Applicant:*
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Employment Application Form

Education

Student Teaching Experience

Administration Experience

Teaching Experience

Coaching Interest

Coaching Experience

Work Experience - Non-Certified

Work Experience - Non-Certified 2

Work Experience - Non-Certified 3

References

Availability

Criminal Record