ELPS_Application

EAST LONGMEADOW PUBLIC SCHOOLS

180 Maple Street

East Longmeadow, MA 01028

(413) 525-5450

TEACHER APPLICATION FORM

(TO BE COMPLETED PRIOR TO OR AT THE TIME OF INTERVIEW)

IT IS THE POLICY OF THE EAST LONGMEADOW PUBLIC SCHOOLS TO PROVIDE EQUAL EMPLOYMENT OPPORTUNITIES WITHOUT REGARD TO RACE, COLOR, RELOGION, SEX, SEXUAL ORIENTATION, OR NATIONAL ORIGIN. EQUAL EMPLOYMENT OPPORTUNITY SHALL, RESPECTFULLY, BE MADE AVAILABLE IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE LAWS

DATE OF APPLICATION: ___________________________________

POSITION: ____________________________________

SOCIAL SECURITY NUMBER: ________________________________

PERSONAL DATA

________________________________________________________________________________

Last name First Name Middle Initial

________________________________________________________________________________

Present Home Address Telephone

________________________________________________________________________________

Present Business Address Telephone

WHAT CERTIFICATIONS/LICENSES DO YOU HOLD?

FIELD STATE CERTIFICATE NUMBER

______________________________ _____________ ___________________

PROFESSIONAL PREPARATION

UNDERGRADUATE:

DEGREE/DATE

INSTITUTION DATES ATTENDED SPECIALIZATION GRANTED

___________________________ _____________________ ___________________ ____________

GRADUATE:

DEGREE/DATE

INSTITUTION DATES ATTENDED SPECIALIZATION GRANTED

___________________________ _____________________ ___________________ ____________

ADDITIONAL:

DEGREE/DATE

INSTITUTION DATES ATTENDED SPECIALIZATION GRANTED

___________________________ _____________________ ___________________ ____________

HONORS AND AWARDS:

_______________________________________________________________________________________________________________________________________________________________________________

PROFESSIONAL EXPERIENCE

Beginning with Your most recent employment, please list below all full time experience in the field of education:

Dates No. of Position or School District Street Immediate

From/To Years Organization or Organization Address Superior______

_________ _______ ___________ __________________ ______________ _____________

ADDITIONAL WORK EXPERIENCE

Please list additional full or part time experience beginning with the most recent dates below:

Dates No. of Position or School District Street Immediate

From/To Years work description or Organization Address Superior______

_________ _______ ___________ __________________ ______________ _____________

REFERENCES (list 3 references below.)

Give as a reference someone who would have first-hand knowledge of your character, personality, scholarship and teaching ability. If an experienced teacher, list the names of superintendents, principals, or supervisors for whom you have worked. Letters should be forwarded to East Longmeadow Public Schools Superintendent's Office unless they are included with other application materials. Supervisors from current and last employers must be given.

NAME POSITION ADDRESS TELEPHONE (include area code)

_____________ _________________ ______________________________ ( )__________________

APPLICANT INFORMATION ITEMS

1. Date available to begin work? _________________________.

2. Are you legally authorized to accept employment in this country?______________________.

3. Do you have reliable means of transportation to get to work on time each day?_______________.

4. Are you physically able to perform all those performance responsibilities as outlined by the state of Massachusetts for certified teachers?______________.

5. Have you ever been convicted of a crime or are you a defendant in a criminal proceeding?_______________________.

6. Are you currently on "lay-Off" or "Reduction In Force (RIF) status and subject to recall from another job?________________.

7. Are you currently employed?______________.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that East Longmeadow Public Schools will submit my name to the Criminal Systems History Board for a review and that reported evidence of a convicted crime may result in discharge. I also understand that I am to abide by all policies, rules and regulations of East Longmeadow Public Schools.

_____________________________________ _______________________

Applicant Signature Date

APPLICATION INSTRUCTIONS

To be considered complete, all applications must include the following:

1. A completed application form (this form).

2. A current resume.

3. Transcripts indicating degrees awarded (to be requested by applicant).

4. Evidence of certifiability or licensure in Massachusetts for the position.

5. Three letters of recommendation (one must be from current employer).

6. Completion of CORI (will be submitted by East Longmeadow Public Schools).

Please continue to back page

APPLICANT'S STATEMENT

I hereby state that the information given by me in this application is true in all aspects. I understand that if I am employed and the information is found to be false in any respect, I will be subject to dismissal without notice at any time. I recognize that an unfavorable report from the Criminal History Systems Board (CORI) may be cause for immediate dismissal. I hereby authorize my former employers to release information pertaining to my work record, my work habits, and my work performance while in their employ. I hereby authorize the individuals listed as personal references to release any personal information that may pertain to my work habits or work performance.

I understand that Massachusetts' laws may require, at some point in the election process, that the information contained in this application be made available to the public. I understand also that the facts set forth herein will be subject to verification.

__________________________________

_____________________________________________ ______________________________

Signature Date

EAST LONGMEADOW PUBLIC SCHOOLS

IS AN EQUAL OPPORTUNITY EMPLOYER

AND DOES NOT DISCRIMINATE ON THE BASIS OF AGE,

SEXUAL PREFERENCE, RACE, COLOR, RELIGION, GENDER,

HANDICAP, OR NATIONAL ORIGIN.