PCSC Certified Application

Certified (Licensed Educator) Staff Employment Application

Paoli Community School Corporation does not discriminate on the basis of age, race, color, religion, gender, marital status, handicap/disability, or national origin.
Date of Application*

MonthDayYear
Position(s) Desired*
Select Grade Level Range for Desired Position(s)*

K-67-12K-12Admin
Name (First MI Last)*
Present Address*
Home Phone*
Cell/Other Phone
Email*
Social Security Number*
Indiana Teacher Retirement #
Present/Most Recent Employer, Job Title, Dates of Employment*
Reason for Leaving Present/Most Recent Employment*
Most Recent Administrative Supervisor(s) & Contact Info*
List ALL employers, job titles & dates of employment for the past ten (10) years*
Explain any dismissal from a position or resignation in order to avoid dismissal*
Teaching License Area(s), License # and Expiration Date(s)*
Educational History (HS, Undergrad, Grad - include majors & minors)*
College Activities in Which You Participated
Location(s), dates, grades, content area(s) and supervisors of student teaching experience(s)*
Contractual Teaching Experience (Location, dates, content/grade level, supervisors)*
Teaching contract years of experience*
List Professional Organizations to Which You Belong
List Specific Talents, Abilities or Honors
Reference #1*
Reference #2*
Reference #3*
List Any Relatives Now Employed by Paoli Community School Corporation*
Military Experience
Please Describe: A) Why You Desire to Work at Paoli Community Schools, B) Goals or Needs for Professional Growth & Development, C) Professional Goals for the Future*
Please Describe: A) Your Core Beliefs About Education, B) Any Qualifications You Wish to Stress, C) Any Additional Information You've Not Been Able to Provide Above*
Have you been convicted of a crime (misdemeanor or felony)?*

YesNO
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, county and state, and type(s) of rehabilitation.*
Attach resume or any other requested documents (letters of reference, license, transcripts, etc.)

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E-Initials: By writing initials and submitting, the applicant guarantees he or she was the only person to complete any and all parts of this online application. The applicant authorizes agents of PCSC to investigate all statements contained in the submitted application. The applicant understands false or misleading information may be cause for dismissal. If agreed, write your initials before submitting (IP ADDRESSES AUTOMATICALLY ACCOMPANY APPLICATION)*
A copy of your submitted application will be sent to the email address provided in your application. Since personal and private information is contained in your submitted application, ONLY submit this application if the email account provided is secure and accessible only by you.
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Certified (Licensed Educator) Staff Employment Application