Dollarway School District AWS
CERTIFIED EMPLOYMENT APPLICATION
Dollarway School District An Equal Opportunity Employer
Barbara J. Warren, Superintendent 4900 Dollarway Road; Pine Bluff, AR 71602 www.dollarwayschools.org Phone: 870-534-7003 Dear Applicant, We appreciate your interest in our school system and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in considering you for a position that best meets your qualifications. Candidates will be contacted for interviewing only when a vacancy occurs, and after an initial screening of applications related to job requirements for that particular position. Specific information is necessary to adequately evaluate an applicant’s qualifications. Please complete all items. Write N/A if the item is not applicable. Applicants for teaching positions in the Dollarway School District must file the following documents in the Superintendent’s Office: 1. Completed and signed application for employment (Resume’ will be accepted, but application process will not be complete until signed application has been submitted) 2. An official transcript (photocopy can be accepted temporarily, but application will not be complete until official transcript is received) 3. Photocopy of Arkansas Teaching Certificate or Statement of Eligibility (if issued) 4. Documentation of any professional certificate, license, credential held 5. Three (3) Letters of Recommendation Note: Completed applications and supporting documents may be sent via: a. Mail Dollarway School District ATTN: Human Resources 4900 Dollarway Road Pine Bluff, AR 71602 b. Email: [email protected]. *THIS APPLICATION WILL REMAIN ACTIVE FOR THE CURRENT SCHOOL YEAR ONLY. (An active file of candidates is started on July 1 of each year.) Should you desire your application to remain active for the next school year, you must notify us in writing.
CERTIFIED EMPLOYMENT APPLICATION
Dollarway School District An Equal Opportunity Employer
Please Print ___________________ Date
PERSONAL DATA: Social Security Number ____________________ Name________________________ Last
Date of Birth __________________
____________________________ ______________ First
Middle or Maiden
Address_______________________________________ _______________________________ City, State Zip No. Street Telephone Number: (Home) ______________________
(Cell) ______________________
How did you learn about the position you are applying for? ___________________________ Are you eligible to work in the United States? _____________
Certification Standard or Provisional
Level or Area of Certification
List any Endorsements
State Issued
Year Issued
Position(s) Desired Indicate Choice First Choice Second Choice
Elementary K-5
Middle 6-8
High School 9-12
Administrator/Other
WORK EXPERIENCE: (List in order of most recent experience)
You may skip this section if a resume is attached and provides the requested information. Job Title/Type of Work
Employer
Address
Dates From
To
If you are currently working, please complete the following. If not list N/A: Employer
Position Title
Current Salary
Contract Period
CHARACTER AND FITNESS: Please respond to the following questions as directed.
1. Have you ever had a professional certificate, license, credential, or any document issued to you denied, suspended, revoked, or voluntarily surrendered? Yes / No 2. Are you currently being reviewed or investigated for purposes of such action as stated in # 1 or is such action pending? Yes / No 3. Have you ever been dismissed, resigned, or asked to resign/retire or discharged from a professional position, (education or otherwise) or military service for immorality, incompetence, willful neglect of duty, misconduct, or presenting false information toward obtaining the position? Yes / No If yes, give details
below. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________
4. Is any such action as stated in # 3 pending? Yes / No If yes, give details below. _______________________________________________________________________________________ _______________________________________________________________________________________ 5. Have you ever been convicted of a felony or misdemeanor (other than a moving traffic violation), been found guilty or entered a plea no contest, even if adjudication was withheld, in Arkansas or any other state? Yes / No If yes, list violation and date of conviction: _______________________________________________________________________________________ _______________________________________________________________________________________ If you indicated “yes” to any items listed above, has that conviction been reviewed by the Education Professional Standards Board? Yes / No If yes, date of review: _______________________
REFERENCES:
Please provide three references who can attest to your character and work ethics and provide information about your employment history. NAME
ADDRESS/PHONE
BUSINESS/AFFILIATION
YEARS ACQUAINTED
I affirm and declare that all information given by me on this form is true, correct, and complete to the best of my knowledge. I understand that any misrepresentation of facts, by omission or addition, may result in the denial or revocation of my teaching certificate, and if employed by the school system, my contract may be voided. I understand there is a CODE OF ETHICS applicable to school personnel and agree to abide by its terms during the course of my career as a professional educator.
Signature _________________________________________
Date ____________________
Dollarway School District An Equal Opportunity Employer
Barbara J. Warren, Superintendent 4900 Dollarway Road; Pine Bluff, AR 71602 www.dollarwayschools.org Phone: 870-534-7003 Dear Applicant, We appreciate your interest in our school system and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in considering you for a position that best meets your qualifications. Candidates will be contacted for interviewing only when a vacancy occurs, and after an initial screening of applications related to job requirements for that particular position. Specific information is necessary to adequately evaluate an applicant’s qualifications. Please complete all items. Write N/A if the item is not applicable. Applicants for teaching positions in the Dollarway School District must file the following documents in the Superintendent’s Office: 1. Completed and signed application for employment (Resume’ will be accepted, but application process will not be complete until signed application has been submitted) 2. An official transcript (photocopy can be accepted temporarily, but application will not be complete until official transcript is received) 3. Photocopy of Arkansas Teaching Certificate or Statement of Eligibility (if issued) 4. Documentation of any professional certificate, license, credential held 5. Three (3) Letters of Recommendation Note: Completed applications and supporting documents may be sent via: a. Mail Dollarway School District ATTN: Human Resources 4900 Dollarway Road Pine Bluff, AR 71602 b. Email: [email protected]. *THIS APPLICATION WILL REMAIN ACTIVE FOR THE CURRENT SCHOOL YEAR ONLY. (An active file of candidates is started on July 1 of each year.) Should you desire your application to remain active for the next school year, you must notify us in writing.
CERTIFIED EMPLOYMENT APPLICATION
Dollarway School District An Equal Opportunity Employer
Please Print ___________________ Date
PERSONAL DATA: Social Security Number ____________________ Name________________________ Last
Date of Birth __________________
____________________________ ______________ First
Middle or Maiden
Address_______________________________________ _______________________________ City, State Zip No. Street Telephone Number: (Home) ______________________
(Cell) ______________________
How did you learn about the position you are applying for? ___________________________ Are you eligible to work in the United States? _____________
Certification Standard or Provisional
Level or Area of Certification
List any Endorsements
State Issued
Year Issued
Position(s) Desired Indicate Choice First Choice Second Choice
Elementary K-5
Middle 6-8
High School 9-12
Administrator/Other
WORK EXPERIENCE: (List in order of most recent experience)
You may skip this section if a resume is attached and provides the requested information. Job Title/Type of Work
Employer
Address
Dates From
To
If you are currently working, please complete the following. If not list N/A: Employer
Position Title
Current Salary
Contract Period
CHARACTER AND FITNESS: Please respond to the following questions as directed.
1. Have you ever had a professional certificate, license, credential, or any document issued to you denied, suspended, revoked, or voluntarily surrendered? Yes / No 2. Are you currently being reviewed or investigated for purposes of such action as stated in # 1 or is such action pending? Yes / No 3. Have you ever been dismissed, resigned, or asked to resign/retire or discharged from a professional position, (education or otherwise) or military service for immorality, incompetence, willful neglect of duty, misconduct, or presenting false information toward obtaining the position? Yes / No If yes, give details
below. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________
4. Is any such action as stated in # 3 pending? Yes / No If yes, give details below. _______________________________________________________________________________________ _______________________________________________________________________________________ 5. Have you ever been convicted of a felony or misdemeanor (other than a moving traffic violation), been found guilty or entered a plea no contest, even if adjudication was withheld, in Arkansas or any other state? Yes / No If yes, list violation and date of conviction: _______________________________________________________________________________________ _______________________________________________________________________________________ If you indicated “yes” to any items listed above, has that conviction been reviewed by the Education Professional Standards Board? Yes / No If yes, date of review: _______________________
REFERENCES:
Please provide three references who can attest to your character and work ethics and provide information about your employment history. NAME
ADDRESS/PHONE
BUSINESS/AFFILIATION
YEARS ACQUAINTED
I affirm and declare that all information given by me on this form is true, correct, and complete to the best of my knowledge. I understand that any misrepresentation of facts, by omission or addition, may result in the denial or revocation of my teaching certificate, and if employed by the school system, my contract may be voided. I understand there is a CODE OF ETHICS applicable to school personnel and agree to abide by its terms during the course of my career as a professional educator.
Signature _________________________________________
Date ____________________
