2. Present Street Address
(please include city, state and zip)
Telephone Number
What the best days and times to
reach you during the day?
Email Address
2. Permanent Street Address
(please include city, state and zip)
B. EMPLOYMENT PREFERENCE:
1. Type of Application
Certified
Elem
Sec
Area
Paraeducator
Elem
Sec
Either
2. Kind of Employment
Full-time
Part-time
3. Are you legally eligible to work in the U.S.?
Yes
No
4. Preferred District
Check all that apply.
Baldwin
Eudora
Wellsville
1. Are you now under contract?
Yes
No
If so, where?
(Optional)
2. Present annual salary
(Optional)
Expected salary range
(Optional)
3. When are you available?
4. Why do you wish to leave your present position?
5. Do you now hold a Kansas Teaching Certificate?
Yes
No
6. Please list in order of preference the
positions for which you are certified:
(To be completed by Certified Staff Only)
A.
B.
C.
D.
Name & Location of Institution
Degree (if applicable)
High School
College or University Under Graduate
College or University Graduate
List college credit earned
since completing last degree
D. RECORD OF EDUCATIONAL EXPERIENCE:
(For certified applicants only)
Begin with most recent employment. A year of teaching is at least seven months
of regular full-time teaching.
1. Name of School
Mailing Address
City/State/Zip
From - To Date
No. of Years or Months
Grades, Subjects, Position
2. Name of School
Mailing Address
City/State/Zip
From - To Date
No. of Years or Months
Grades, Subjects, Position
3. Name of School
Mailing Address
City/State/Zip
From - To Date
No. of Years or Months
Grades, Subjects, Position
4. Name of School
Mailing Address
City/State/Zip
From - To Date
No. of Years or Months
Grades, Subjects, Position
E. STUDENT TEACHING OR PRACTICUUM EXPERIENCE:
(For certified applicants only)
List all areas and cooperating teachers.
1. Name of School
Mailing Address
City/State/Zip
Area (Grade or Subjects)
Dates
Name of Cooperating Teachers
2. Name of School
Mailing Address
City/State/Zip
Area (Grade or Subjects)
Dates
Name of Cooperating Teachers
F. OTHER EXPERIENCE:
(For all applicants)
Begin with most recent employment and include U.S. military service.
1. Firm or Employer
Mailing Address
City/State/Zip
Kind of Work
Dates of Employment
No. of Years
2. Firm or Employer
Mailing Address
City/State/Zip
Kind of Work
Dates of Employment
No. of Years
3. Firm or Employer
Mailing Address
City/State/Zip
Kind of Work
Dates of Employment
No. of Years
4. Firm or Employer
Mailing Address
City/State/Zip
Kind of Work
Dates of Employment
No. of Years
G. REFERENCES:
List in the spaces provided at least three or more
references (not relatives) including administrative and supervisory
personnel who have first-hand knowledge of your performance and/or future
potential in the area for which you are applying.
Please be sure to provide both work and home numbers, since references are
often not available at work numbers during certain times of the year.
1. Name
Mailing Address
City/State/Zip
Position
Home Phone Number
Work Phone Number
2. Name
Mailing Address
City/State/Zip
Position
Home Phone Number
Work Phone Number
3. Name
Mailing Address
City/State/Zip
Position
Home Phone Number
Work Phone Number
4. Name
Mailing Address
City/State/Zip
Position
Home Phone Number
Work Phone Number
Your application will be filed according to the type of position(s) for which you are
applying. You may inquire as to your employment status after you have supplied all
requested information, including credentials (for certified applicants).
NOTE: This application is valid for one year only from the date of application.
Please notify us if you wish to keep this application on file.
Requirements for Employment: If you are offered a contract, you must have
an official transcript, credentials, a Kansas teacher's certificate and a current
health certificate on file with the Cooperative Office before you will receive
payment under the contract.
If you provide false, inaccurate or incomplete information in this application
form or in any interview or if you fail to disclose informa- tion requested in
this application or in any interview, you will not be eligible for employment,
or, if you are hired, you will be subject to termination.
I have completed this application to the best of my knowledge and do swear that
all information stated herein is accurate and complete. I, the undersigned,
hereby give my permission to East Central Kansas Cooperative in Education,
Baldwin City, Kansas, to make job related inquiry of any and all employers and
references listed in this application. Requirements for Employment: If you are
offered a contract, you must have an official transcript, credentials, a Kansas
teacher's certificate and a current health certificate on file with the
Cooperative Office before you will receive payment under the contract.
If you provide false, inaccurate or incomplete information in this application
form or in any interview or if you fail to disclose informa- tion requested in
this application or in any interview, you will not be eligible for employment,
or, if you are hired, you will be subject to termination.
I have completed this application to the best of my knowledge and do swear that
all information stated herein is accurate and complete. I, the undersigned,
hereby give my permission to East Central Kansas Cooperative in Education,
Baldwin City, Kansas, to make job related inquiry of any and all employers and
references listed in this application.
Yes, I have read and agree to these terms.
Inter-Local #614 does not discriminate on the basis of sex, race, color, national origin, disability, or age when considering applicants for employment. Any questions regarding the Board's compli- ance with Title VI, Title IX, Americans with Disability Act, or Section 504 may be directed to the local Title IX Coordinator, who can be reached at (785) 594-2737; 715 Chapel Street; Baldwin City, KS. 66006-0041, or the Kansas Title IX Coordinator who can be contacted at (785) 296-2424, 120 S.E. 10th Avenue; Topeka, KS. 66612-1182, or to the Assistant Secretary of Civil Rights, U.S. Department of Education.
