EDUCATOR APPLICATION |
Return to: |
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| Date | Social Security # | ||
| Name (Last/First/Middle) | |||
| Address (Street/City/State/Zip) | |||
| Home Phone | Phone number during the day | ||
| Birth Place (optional) | Date of Birth (optional) | ||
| Position(s) for which you are applying | |||
| Do you hold a current teaching certificate? | For which state? | ||
| In what subject area? | When does it expire? | ||
| Have you ever been convicted of a felony? | YES |
NO | If yes, please explain: |
| EDUCATIONAL PREPARATION (List most current education first) | |||||
Inclusive Dates |
Name & Address of School |
Degree |
Credits Earned |
Major/Minor |
Date of Graduation |
| EXPERIENCE (List student teaching and all paid educational experience) | ||||
Grade / Subject Taught |
Name & Address of School |
Dates |
Principal / Director & Phone Number
|
Number of Qtrs / Smstrs |
| Student Teaching | ||||
| OTHER WORK EXPERIENCE | |||
Dates of Employment |
Employer's Name & Address |
Type of Work & Position Held Full or Part-time |
Telephone Number |
| REFERENCES (If available, a college placement bureau file is preferable over individual references) | |||
| Name |
Address |
Position / Business |
Telephone |
| ADDITIONAL INFORMATION (List any other information which will assist us in reaching a true estimate of your qualifications) |
| PLEASE ANSWER THE FOLLOWING QUESTIONS |
| 1. What are your three most important reasons for wanting to be a teacher? |
| 2. In order to be most helpful to students, how much do you want to know about them? |
| 3. What three things do you most want to know about your students? |
| 4. What do you need to know in order to begin your lesson planning for a class? |
| 5. What four key components do you believe you must include in your lesson plan? |
| 6. When you think about your students, in what major ways do you most want to influence their lives? |
| 7. Referring to #6, what two core teaching strategies do you use most to achieve the desired results? |
| 8. What does it mean to integrate technology into the curriculum? |
| 9. How would you use technology in this job? |
AFFIRMATION: I certify that all statements made in this application are true and correct, and that any misstatement of material facts may subject me to disqualification or dismissal. Also, I authorize investigation of all statements made in this application. Signature: _____________________________________________________________________________________ Date: |