Lakin USD #215 Certified Staff Employment Application
Unified School District #215 1003 W. Kingman Lakin KS 67860 Phone (620) 355-6761 Fax (620) 355-7317
INFORMATION FOR APPLICANT: Please complete all items on this application form accurately and in detail. You should request your college placement office to forward your up-to-date credentials and a copy of your transcripts. Personal interviews are required prior to consideration for employment. This application will remain active for a period of one year. Application materials may be re-activated for an additional year by request of the applicant. If you wish to be considered for employment after that time, you must re-apply. PLEASE TYPE OR PRINT CLEARLY.
First Name
Middle Name
Other names under which your records might appear
Last Name
Social Security Number
Street Present address until: ________________
Street Permanent address if different:
Apt
Apt
City
City
State
Zip
State
Phone
Zip
Phone
(
)
(
)
(
)
Name and address of someone who will always know how to locate you. Name
Street
City, State, Zip
Date of application ________________________
Phone
Date available for employment_________________________
For Office Use Only Interview Date
College
Hire Date
Degree/Hours
Column
Step
Extra Days
Total Teaching Experience
Total Number Of Contract Days
Salary
Supplemental Salary
Assignment
Position
FTE
POSITIONS DESIRED In this section, please enter the area(s) for which you wish to be considered for employment. Please list in priority order, so we know the positions to consider your areas of major interest. Do not list any area for which you cannot be certified. Use the extra space in “Positions Desired” for notes and comments.
1
2
3
Please list activities or coaching assignments you are willing to accept.
EDUCATIONAL BACKGROUND
SCHOOL High School
College
UnderGraduate
Graduate
List college credit
earned since
completing last degree
NAME AND LOCATION OF INSTITUTION
DATE(S)
DEGREE
Major(s) In Undergraduate Work
Semester Hours
Major(s) in Graduate Work
Semester Hours
PROFESSIONAL INFORMATION I am currently certified in Kansas I am currently certified in another state: _______________ I am seeking certification I anticipate being certified in the following areas:___________________________________________ Areas in which you are certified: (Please leave blank if you are not yet certified.) ____________________________________________________________________________________________ ____________________________________________________________________________________________ Does your certificate qualify you in Kansas in the position for which you are applying? ______________________ Are you currently under contract? _________ When will you be available for work? ______________________________________________________________
College or University Placement Office where your credentials are on file: ____________________________________________________________________________________________ Name and Location of Institution
CHECK ONE Credentials have been forwarded to Lakin USD #215. Credentials will be forwarded on or about this date: ____________ I have not requested credentials from my placement office.
PROFESSIONAL EXPERIENCE Starting with the most recent years, list each year of teaching or administrative experience, including partial year, part-time teaching and student teaching. DO NOT list paraprofessional positions, substitute teaching or graduate teaching assistantships.
From Mo/Yr
To Mo/Yr
Months Total
School Complete CompleteAddress Address
Assignment Assignment
Reason For Leaving Leaving
REFERENCES Please list the names of three persons whom you authorize Lakin USD #215 to contact for references concerning your qualifications. The district reserves the right to contact additional individuals concerning your qualifications for employment.
Name
Title
Address
Phone
PERSONAL DATA Have you ever been convicted of any crime?
Yes________ No ________
If yes, please explain: __________________________________________________________________________ Conviction of a crime is not an automatic bar to employment. USD #215 will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position for which you are applying. Have you ever had a teaching certificate revoked in Kansas or any other state?
Yes________ No ________
If appointed to the staff, are you willing to accept assignments where you are needed? Yes________ No________ CERTIFICATION, AUTHORIZATION AND RELEASE I hereby certify that the statements made by me in this application and all related information, which I have provided, are true, accurate, and complete to the best of my knowledge. I understand that if I provide any false, inaccurate, or incomplete information, I will not be eligible for employment, or, if I am hired, I may be terminated regardless of the date on which USD #215 discovers, the false inaccurate, or incomplete information. I authorize investigation by USD #215 of all statements contained in this application. I specifically authorize USD #215 to conduct a background investigation of personal, employment, educational, military, and criminal conviction records or history. I agree to execute such separate disclosure, authorization and release forms and fingerprint cards as may be required by USD #215 in connection with any of the foregoing, and I grant permission to USD #215 to contact all references listed herein. I expressly authorize the release to USD #215 of any records or information which may refer or relate to this application for employment, including, but not limited to, records of educational institutions, law enforcement or criminal justice agencies, agencies maintaining child abuse records, and previous employers. I hereby release and discharge USD #215 and any other person, firm, agency or corporation related thereto from any and all claims and liability which I may have or ever claim to have relating to information provided to USD #215 as part of this application for employment. Please attach a letter or resumé to this application if you would like to include any additional information that will give us a more complete estimate of your training, experience, character and ability I understand the USD #215 and its agents are required to abide by all applicable laws in connection with any background investigation, and this authorization and waiver does not affect any rights and/or obligations under any such applicable laws. A photocopy of this authorization shall have the same force and effect as the original. SIGNATURE OF APPLICANT If this application is being submitted in person or by mail, it must be signed by applicant. If this application is being submitted electronically, (e-mail), applicant should obtain a printed copy of this Certification, Authorization and Release, and forward the signed Certification, Authorization and Release to USD #215 at the address noted below. If USD #215 does not receive a signed Certification, Authorization and Release from applicant within seven (7) days of receipt of any electronically submitted application, USD #215 will forward a Certification Authorization and Release to applicant at the address noted in this application, and a signed Certification, Authorization and Release must be executed by applicant and immediately returned to USD #215. USD #215 may verify the submission of this application and the request for release of records and information through telephone confirmation. ___________________________________________ __________________________________________ Date
Printed or Typed Name
__________________________________________ Signature Lakin USD #215, 1003 W. Kingman, Lakin KS 67860 620-355-6761 Lakin USD #215 does not discriminate on the basis of sex, race, color, national origin, disability, or age in admission or access to, or treatment or employment, its programs or activities. Any questions regarding the school district’s compliance with Title VI, Title IX, ADA, or Section 504 may be directed to the Coordinator, who is Superintendent of Schools, Sue King, 1003 W. Kingman, Lakin KS 67860, or call 620-355-6761. The Assistant Secretary for Civil Rights, U.S. Department of Education is also available.
APPLICATION AND INTERVIEW PROCEDURE STEP 1
The first step in the interview process is to submit a completed application file to Lakin USD #215. Applicant files must be complete before a screening interview will be arranged. A completed file consists of: a)
A completed application
b)
College transcripts
c)
A photocopy of the teaching certificate or letter explaining the status of teaching certification
d)
College credentials
STEP 2
Once an applicant has completed an application file, the material will be reviewed by the superintendent of schools.
STEP 3
When an actual vacancy is announced, qualified candidates will be selected and contacted by the superintendent. Candidates are chosen for finalist interviews by the superintendent and building principal.
STEP 4
The names of candidates recommended for employment will be placed before the Lakin USD #215 Board of Education.
STEP 5
Employment is contingent upon the outcome of a background check (name/fingerprinting) and/or a physical exam, which may include drug screening.
STEP 6
Applicants should contact the Lakin USD #215 district office yearly to reactivate their file.
IF YOU HAVE ANY QUESTIONS, PLEASE DO NOT HESITATE TO CONTACT ME AT (620) 355-6761. Mrs. Sue King Superintendent 1003 W. Kingman Lakin KS 67860