Personal Information
Today's Date:
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Full Name:
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First Name
Last Name
E-mail:
Phone Number:
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Area Code
Phone Number
Social Security Number:
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Address (Street):
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Address (City):
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Address (State / Zip):
Teaching position(s) applying for:
Currently under contract?
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Yes
No
If yes, where?
When are you available to report?
Why do you wish to leave your current position?
Certification Information
Certificate presently held:
None
Valid Oklahoma Standard
Valid Oklahoma Provisional
Will receive Oklahoma Certificate upon graduation
Have taken the Oklahoma Curriculum Test
Undergraduate GPA:
Major:
Minor:
Degree:
Bachelor's
Bachelor's +16
Master's
Master's +16
Master's +32
Doctor's
Major teaching areas as listed on license or certificate:
Minor teaching areas as listed on license or certificate:
Can you speak a language other than English, if so which?
Other:
Scholastic Preparation
Name and location of school, dates, and degree type:
Name and location of school, dates, and degree type:
Student Teaching: Include the institution name, dates, grade, subject or position and principal's name.
Work Experience
List each work experience, including part-time or substitute teaching.
Name and location of school, dates, grade and subject, and principal:
List each work experience, including full-time teaching (signed contract for one full semester or more).
Name and location of school, dates, grade and subject, and principal:
List each work experience, including coaching or sponsorship experience.
Position, school district, and dates.
Number of years teaching in Oklahoma:
Number of years teaching in other states:
Number of years of military experience:
Number of years as a school administrator:
References Information
List the name, full address, phone number, and position of each reference:
Is there any reason you could not effectively perform the functions required of the job?
Yes
No
If yes, explain:
Are you related to a member of the Altus Board of Education?
Yes
No
If yes, how?
Have you ever been convicted of a felony?
Yes
No
If yes, explain:
Have you ever been discharged from any teaching position?
Yes
No
If yes, explain:
Have you established a placement folder?
Yes
No
If yes, list institution:
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Applicant's Statement
I grant Altus Public Schools permission to contact any or all former employers and references or other sources they see fit to verify information with regard to my character and qualifications. All persons, firms, and entities are hereby authorized to release any information or records concerning me to Altus Public Schools and are released by me from any liability as a result of furnishing records and information.
I hereby certify that all above questions are fully and correctly answered. I understand that any misleading or incorrect statements may render this application void, and if employed, would be cause for my termination.
I understand that the application will remain active for one year after its completion and that I must notify the district, in writing, if I wish to be considered beyond that period.
Enter your initials in the following box to create your digital signature and agree with all stated above.
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