Application for Employment
Fields with an * are required fields
Position Applied for:
Administrative (specify)
Agriculture
Art
Athletic Director
Biology
Chemistry
Counselor
Driver Education
Driver Education / Physical Education
English
French
Health/Phys Ed
Head Football Coach
Librarian
Mathematics
Music
School Nurse
Physical Science
Physics
Psychologist
Reading
School Based Intervention
Science
Social Studies
Spanish
Special Education
Speech & Hearing Therapist
Vocational/Technical (specify)
Other (specify)
If "Vocational":
Please Specify
Building Construction
Computer Aided Drafting
Electrical Construction
Environmental Science
Masonry
Automotive Body Repair
Automotive Technology
Aviation/ROTC
Electronics
Welding
Business Education
Cosmetology
Radio/TV
Visual Communications
Network Engineering
Child Development
Criminal Justice
Dental Assisting
Medical Assisting
Nurse Assisting
Health Aide
If "Administrative":
Please Specify
Assistant Principal
Principal
Admissions Coordinator
Administrative Assistant
Assistant Superintendent
Superintendent
Business Manager
Supervisor of Buildings and Grounds
Supervisor of Transportation
Supervisor of Technology
Cafeteria Manager
Supervisor of Instruction
If "Other" please specify:
*
First Name:
*
MI:
*
Last Name:
*
Address:
*
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WV
WI
WY
*
Zip:
*
Telephone Number:
*
Email:
*
Social Security Number:
Have you ever filed an application with us before?
Yes
No
If yes, what area(s):
Have you ever been employed with us before
Yes
No
If yes, what area(s):
Are you currently employed?
Yes
No
Have you ever been convicted of a felony?
Yes
No
If yes, please explain:
Educational Preparation
High School
Name of School:
Address:
(Cont.)
Year Graduated:
Diploma/Degree:
Major/Minor:
College1
Name of School:
Address:
(Cont.)
Year Graduated:
Diploma/Degree:
AA
BA
BS
Certificate
DR
Ed.D.
MA
MBA
MDIV
MS
M.Ed.
Ph.D.
Major/Minor:
College2
Name of School:
Address:
(Cont.)
Year Graduated:
Diploma/Degree:
AA
BA
BS
Certificate
DR
Ed.D.
MA
MBA
MDIV
MS
M.Ed.
Ph.D.
Major/Minor:
College3
Name of School:
Address:
(Cont.)
Year Graduated:
Diploma/Degree:
AA
BA
BS
Certificate
DR
Ed.D.
MA
MBA
MDIV
MS
M.Ed.
Ph.D.
Major/Minor:
College4
Name of School:
Address:
(Cont.)
Year Graduated:
Diploma/Degree:
AA
BA
BS
Certificate
DR
Ed.D.
MA
MBA
MDIV
MS
M.Ed.
Ph.D.
Major/Minor:
Other
Name of School:
Address:
(Cont.)
Year Graduated:
Diploma/Degree:
AA
BA
BS
Certificate
DR
Ed.D.
MA
MBA
MDIV
MS
M.Ed.
Ph.D.
Major/Minor:
Professional Growth Credits:
Choose One
No Degree
B
B+15
B+30
M+15
M+30
M+45
M+60
Doctorate
Praxis skills test of reading, writing, and mathematics Test Score:
Date Taken:
Professional Experience
1
Employer:
Address:
Telephone Number:
Job Title:
Supervisor:
Work Performed:
Dates Employed:
From
To
Reason for Leaving:
2
Employer:
Address:
Telephone Number:
Job Title:
Supervisor:
Work Performed:
Dates Employed:
From
To
Hourly Rate/Salary:
Starting
Final
Reason for Leaving:
3
Employer:
Address:
Telephone Number:
Job Title:
Supervisor:
Work Performed:
Dates Employed:
From
To
Hourly Rate/Salary:
Starting
Final
Reason for Leaving:
4
Employer:
Address:
Telephone Number:
Job Title:
Supervisor:
Work Performed:
Dates Employed:
From
To
Hourly Rate/Salary:
Starting
Final
Reason for Leaving:
Do you hold a valid teaching/administrative certificate?:
Yes
No
State:
Field:
Area(s) of Certification (LIST ALL):
Expiration Date:
Extra Curricular Activities
List clubs and/or activities you could direct or sponsor:
List sport(s) for which you are trained and/or qualified to coach:
References
Please list persons whom we may contact for information concerning your professional preparation and competence. Do not list relatives or persons who know you only as a friend or who can evaluate only your personality or character. List your classroom cooperating teacher if your student teaching was done within the last three years.
Contact1
Position:
Name:
Complete Mailing Address:
Telephone #:
Contact2
Position:
Name:
Complete Mailing Address:
Telephone #:
Contact3
Position:
Name:
Complete Mailing Address:
Telephone #:
Other Information
Has your credential ever been suspended or revoked?:
Yes
No
If yes, please explain:
Have you ever been dismissed or asked to resign from teaching?:
Yes
No
If yes, please explain:
Please provide any additional information:
Please read before submitting application:
--- The POLYTECH School District, an equal opportunity Employer, is always glad to receive applications from qualified persons. An application is valid for one year from date of receipt of application. The application may be kept active beyond that date upon written request and by providing any necessary updated information. It is the responsibility of the applicant to forward any official transcripts of his or her college records, credentials, and evidence of certification directly to the personnel office. Applications will be considered complete only when all transcripts, credentials, etc., have been received by the District Personnel Office. --- Assignments are made in accordance with the needs of the school system and are subject to change. Any person signing a contract with the POLYTECH School District accepts these conditions. I hereby authorize the POLYTECH School District to request verification of statements made by me on this employment application. I also give permission to any of my former employers to release the information requested to the POLYTECH School District. Further, I release such employers and the POLYTECH School District from all liability for any damage whatsoever for issuing such information. I certify that all the statements made on this application are true and complete to the best of my knowledge and that and false statements or with holding any information could subject me to disqualification or dismissal. The POLYTECH School District does not discriminate in employment or educational programs, services, or activities based on race, color, national origin, sex, age, or disability.
POLYTECH School District
823 Walnut Shade Road
Woodside, DE 19980-0097
(302) 697-2170
jcrossen@polytech.k12.de.us
