ROCKY CHANNELS SCHOOL SYSTEM
AOS 98 / ROCKY CHANNELS SCHOOL SYSTEM Boothbay, Boothbay Harbor, Edgecomb, Georgetown, and Southport
51 Emery Lane Boothbay Harbor, ME 04538 THE AOS 98-Rocky Channels School System School Committee does not discriminate in the operation of its educational and employment policies and will honor all appropriate laws relative to discrimination.
APPLICATION FOR TEACHER/ADMINISTRATOR Position for which you are applying: (grade level, subject, other)
PERSONAL INFORMATION:
Name: ________________________________________________________________________ First
Middle Initial
Last
Mailing Address: ________________________________________________________________ PO Box or Street Address
______________________________________________________________________________ City or Town
State
Zip Code
Home phone: _____________________________ Cell Phone: __________________________ Work phone: ______________________ Email address: __________________________________________________________________ I may be reached at:
work _____
home ____
cell _____
email _____
APPLICATION INSTRUCTIONS: A complete application packet includes the following:
A completed and signed application form. A cover letter and resume. A copy of your Maine teacher’s certificate or evidence that you are eligible for certification as a teacher in Maine and have submitted an application to the Maine. Department of Education. Copy of College/University transcripts. Letters of reference from three people; can be from references listed on application. PLEASE - NO FAXING APPLICATION PACKETS – E-MAIL OR POSTAL SERVICE ONLY
Send all information to: Eileen King Superintendent of Schools 51 Emery Lane Boothbay Harbor, ME 04538 1
CURRENT SCHOOL DISTRICT INFORMATION: Are you presently under contract to a school district? _____________________________ If yes, when does your contract expire? _______________________________________ Name of district? _________________________________________________________ Position ________________________________________________________________ Present salary ____________________________________ CERTIFICATION INFORMATION: Are you currently certified as a teacher in Maine? Yes ________
No__________
Endorsements in __________________________________________________________ Are you eligible to be certified as a teacher in Maine? Yes _________ No __________ Are you presently certified as a teacher in another state? Yes ________ No __________ If yes, which state (s)? ______________________________________ NOTE: Candidates who do not hold Maine certification should contact the Maine Department of Education, Division of Certification and Placement, Augusta, ME 04333 207-624-6603
ACADEMIC AND PROFESSIONAL DEVELOPMENT College/University
State
Degree
Number of Years Completed___
_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Please have a copy of your college/university transcripts and any other credentials on file sent to the superintendent at the address on this application.
2
MEMBERSHIPS IN PROFESSIONAL ORGANIZATIONS: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ PROFESSIONAL EXPERIENCE: (Please list beginning with your current or most recent experiences) Dates From/To
Position/School District
Responsibilities
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ OTHER RELEVANT WORK EXPERIENCE AND ACHIEVEMENTS ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ CIVIC AND COMMUNITY INVOLVEMENT: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ REFERENCES: List at least three persons, two of whom are your most recent supervisors, who can comment on your ability, and who we may contact. In addition, please provide three letters of reference from persons who are not related to you. (Letters may be from references below). Name
Position
Address
Phone
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
3
OTHER INFORMATION: The AOS 98-Rocky Channels School System School Committee is committed to conducting a thorough screening of applicants for all positions and requires the completion of the following questions of all candidates: In a prior position, have you ever been disciplined, discharged, or asked to resign? Yes_________ No ________ Have you ever been charged with or investigated for sexual abuse or sexual harassment of another person? Yes __________ No ________ Have you (a) ever been convicted of a crime, other than a minor traffic offense; or (b) ever entered a plea of guilty or a plea of “no contest” (nolo contendere), or has any court ever deferred further proceedings without entering a finding of guilty and placed you on probation, for any crime other than a minor traffic offense? Yes __________ No ___________ If you have answered yes to any of the previous questions, please explain in detail on a separate sheet of paper. NOTE: Criminal charges, investigations, arrests, or conviction of a crime are not automatic bars to employment. My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize any persons, agencies, or entities that the AOS 98-Rocky Channels School System School Committee contacts in connection with my employment application to fully provide the AOS 98-Rocky Channels School System School Committee any information requested. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the AOS 98-Rocky Channels School System School Committee, its agents and officials, or against any provider of such information. Any falsification of information or misleading information on this application shall be fully sufficient grounds to refuse to employ or, having been employed, shall be immediate cause for dismissal. All application materials become the property of the AOS 98-Rocky Channels School Department and will remain on file for two years. None will be returned. Providing any false or misleading information on this application or in the application or employment screening process shall be fully sufficient grounds to refuse to employ the applicant or, if the applicant has been employed, to immediately dismiss the applicant/employee. APPLICANT SIGNATURE: _________________________________________ DATE: _________________________ 4
51 Emery Lane Boothbay Harbor, ME 04538 THE AOS 98-Rocky Channels School System School Committee does not discriminate in the operation of its educational and employment policies and will honor all appropriate laws relative to discrimination.
APPLICATION FOR TEACHER/ADMINISTRATOR Position for which you are applying: (grade level, subject, other)
PERSONAL INFORMATION:
Name: ________________________________________________________________________ First
Middle Initial
Last
Mailing Address: ________________________________________________________________ PO Box or Street Address
______________________________________________________________________________ City or Town
State
Zip Code
Home phone: _____________________________ Cell Phone: __________________________ Work phone: ______________________ Email address: __________________________________________________________________ I may be reached at:
work _____
home ____
cell _____
email _____
APPLICATION INSTRUCTIONS: A complete application packet includes the following:
A completed and signed application form. A cover letter and resume. A copy of your Maine teacher’s certificate or evidence that you are eligible for certification as a teacher in Maine and have submitted an application to the Maine. Department of Education. Copy of College/University transcripts. Letters of reference from three people; can be from references listed on application. PLEASE - NO FAXING APPLICATION PACKETS – E-MAIL OR POSTAL SERVICE ONLY
Send all information to: Eileen King Superintendent of Schools 51 Emery Lane Boothbay Harbor, ME 04538 1
CURRENT SCHOOL DISTRICT INFORMATION: Are you presently under contract to a school district? _____________________________ If yes, when does your contract expire? _______________________________________ Name of district? _________________________________________________________ Position ________________________________________________________________ Present salary ____________________________________ CERTIFICATION INFORMATION: Are you currently certified as a teacher in Maine? Yes ________
No__________
Endorsements in __________________________________________________________ Are you eligible to be certified as a teacher in Maine? Yes _________ No __________ Are you presently certified as a teacher in another state? Yes ________ No __________ If yes, which state (s)? ______________________________________ NOTE: Candidates who do not hold Maine certification should contact the Maine Department of Education, Division of Certification and Placement, Augusta, ME 04333 207-624-6603
ACADEMIC AND PROFESSIONAL DEVELOPMENT College/University
State
Degree
Number of Years Completed___
_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Please have a copy of your college/university transcripts and any other credentials on file sent to the superintendent at the address on this application.
2
MEMBERSHIPS IN PROFESSIONAL ORGANIZATIONS: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ PROFESSIONAL EXPERIENCE: (Please list beginning with your current or most recent experiences) Dates From/To
Position/School District
Responsibilities
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ OTHER RELEVANT WORK EXPERIENCE AND ACHIEVEMENTS ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ CIVIC AND COMMUNITY INVOLVEMENT: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ REFERENCES: List at least three persons, two of whom are your most recent supervisors, who can comment on your ability, and who we may contact. In addition, please provide three letters of reference from persons who are not related to you. (Letters may be from references below). Name
Position
Address
Phone
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
3
OTHER INFORMATION: The AOS 98-Rocky Channels School System School Committee is committed to conducting a thorough screening of applicants for all positions and requires the completion of the following questions of all candidates: In a prior position, have you ever been disciplined, discharged, or asked to resign? Yes_________ No ________ Have you ever been charged with or investigated for sexual abuse or sexual harassment of another person? Yes __________ No ________ Have you (a) ever been convicted of a crime, other than a minor traffic offense; or (b) ever entered a plea of guilty or a plea of “no contest” (nolo contendere), or has any court ever deferred further proceedings without entering a finding of guilty and placed you on probation, for any crime other than a minor traffic offense? Yes __________ No ___________ If you have answered yes to any of the previous questions, please explain in detail on a separate sheet of paper. NOTE: Criminal charges, investigations, arrests, or conviction of a crime are not automatic bars to employment. My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize any persons, agencies, or entities that the AOS 98-Rocky Channels School System School Committee contacts in connection with my employment application to fully provide the AOS 98-Rocky Channels School System School Committee any information requested. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the AOS 98-Rocky Channels School System School Committee, its agents and officials, or against any provider of such information. Any falsification of information or misleading information on this application shall be fully sufficient grounds to refuse to employ or, having been employed, shall be immediate cause for dismissal. All application materials become the property of the AOS 98-Rocky Channels School Department and will remain on file for two years. None will be returned. Providing any false or misleading information on this application or in the application or employment screening process shall be fully sufficient grounds to refuse to employ the applicant or, if the applicant has been employed, to immediately dismiss the applicant/employee. APPLICANT SIGNATURE: _________________________________________ DATE: _________________________ 4
