Certified Staff Application
Lafayette County School district
AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL DATA
Reaquired field: LAST NAME:
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Reaquired field: FIRST
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MIDDLE
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Reaquired field: SOCIAL SECURITY NUMBER:
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Reaquired field: Email:
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Reaquired field: PRESENT ADDRESS
Address
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City
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State / Province / Region
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POSITION DESIRED: INDICATE SCHOOL LEVELS AND SUBJECT AREAS IN WHICH YOU ARE PREPARED TO TEACH. GIVE PREFERENCE BY RANKING IN THE APPROPRIATE LEVEL OR SUBJECT AREA.
1.
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2.
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3.
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4.
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5.
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6.
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Check the extra-curricular activities or clubs which you would be willing to sponsor.
EDUCATIONAL AND PROFESSIONAL PREPARATION
LAST ELEMENTARY ATTENDED
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CITY, STATE
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LAST HIGH SCHOOL ATTENDED
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CITY, STATE
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DIPLOMA OR DEGREE
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COLLEGE OR UNIVERSITY
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CITY, STATE
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DIPLOMA OR DEGREE
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COLLEGE OR UNIVERSITY
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CITY, STATE
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DIPLOMA OR DEGREE
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WHAT IS YOUR OVERALL COLLEGE GRADE-POINT AVERAGE? (EXAMPLES:2.8/4.0; 2.8/3.0) OPTIONAL
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GRADE OR SUBJECT IN WHICH YOU DID STUDENT TEACHING
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GRADE EARNED
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SCHOOL
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CITY, STATE
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YEAR
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PLEASE LIST ALL INFORMATION CONCERNING ARKANSAS TEACHER CERTIFICATION HELD:
CERTIFICATION AREAS
If yes, list your areas of certification
If you do not currently hold a teaching certificate, describe your status:
TEACHING EXPERIENCE
DATES EMPLOYED
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NAME OF SCHOOL, CITY, STATE
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GRADES & SUBJECTS TAUGHT
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REASON FOR LEAVING
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DATES EMPLOYED
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NAME OF SCHOOL, CITY, STATE
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GRADES & SUBJECT TAUGHT
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REASON FOR LEAVING
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DATES EMPLOYED
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NAME OF SCHOOL, CITY, STATE
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GRADES & SUBJECTS TAUGHT
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REASON FOR LEAVING
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ADDITIONAL INFORMATION
IF YES, PLEASE STATE WHERE, WHEN, AND THE NATURE OF THE OFFENSE:
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If so, Where?
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REFERENCES (GIVE AT LEAST FIVE REFERENCES INCLUDING SUPERINTENDENTS AND PRINCIPALS FOR WHOM YOU HAVE MOST RECENTLY WORKED AND ONE ADDITIONAL PERSON WHO CAN ATTEST TO YOUR CHARACTER AND QUALIFICATIONS.)
Reaquired field: NAME
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Reaquired field: TELEPHONE NUMBER
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POSITION
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ADDRESS, CITY, STATE, ZIP
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Reaquired field: NAME
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Reaquired field: TELEPHONE NUMBER
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POSITION
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ADDRESS, CITY, STATE, ZIP
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Reaquired field: NAME
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Reaquired field: TELEPHONE NUMBER
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POSITION
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ADDRESS, CITY, STATE, ZIP
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Reaquired field: NAME
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Reaquired field: TELEPHONE NUMBER
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POSITION
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ADDRESS, CITY, STATE, ZIP
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Reaquired field: NAME
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Reaquired field: TELEPHONE NUMBER
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POSITION
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ADDRESS, CITY, STATE, ZIP
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Reaquired field: Please respond to the following. Explain why you chose to enter the teaching profession and why you would like to teach in Lafayette County School District.
DO YOU HAVE ANY ADDITIONAL INFORMATION YOU FEEL WILL HELP US MAKE A BETTER DECISION IN OUR CONSIDERATION OF YOU FOR A POSITION.
REMINDERS TO APPLICANTS: ATTACH A COMPLETE COPY OF YOUR TRANSCRIPT AND A COPY OF YOUR TEACHER CERTIFICATE
Read Carefully before Signing Placement credentials, photocopy of teaching certificate, and an official transcript of all college or university credit should be forwarded to: Superintendent, Lafayette County School District, P.O. Box 950, Lewisville, Arkansas 71845. IF NOT ATTACHED ABOVE. Application forms are sent to all who request them regardless of existing vacancies. The issuance of such forms does not signify that the applicant is under consideration for appointment. The applicant will be notified when an initial interview is scheduled. An application remains active for a period of three years and must be renewed following this period. The facts set forth in my application for employment shall be considered true and complete. I understand that, if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. I also agree to take any medical examination required by the school district. I waive the right to view or examine any personal or employment reference forms that are completed and returned to the district by the persons whom I list as references on this application.
Reaquired field: SIGNATURE OF APPLICANT
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Required Fields