APPLICATION FOR EMPLOYMENT

For what position are you applying?

I. PERSONAL:

Name:	Last	First	Middle
Address:	Street	City	State	Zip Code
Phone Number:	Home	Work
U.S. Citizen?	Yes No
Vaccinated?	Yes No

II. EDUCATIONAL AND PROFESSIONAL TRAINING:

	Name of School or Institution	Address of School or Institution	Major	Dates Attended	Degree
High School			-
College and/or University

Graduate Work

Please provide transcripts from all Undergraduate and Graduate Institutions attended.

III. NEW JERSEY CERTIFICATION:

Please list types and date(s) of issue.

IV. CERTIFICATION IN OTHER STATES:

Please list types and date(s) of issue.

V. EDUCATIONAL WORK EXPERIENCE

If no prior teaching experience, list Practice Teaching and give the name(s) of your cooperating teacher(s) and college supervisor

Dates (FROM-TO)	Name of School	Address of School	Grades and Subjects Taught	Salary

VI. EXTRA-CURRICULAR EXPERIENCE

Year	Place	Nature of Participation

VII. COMMUNITY ACTIVITIES AND INTERESTS:

VIII. MILITARY SERVICE

List dates, branch, duties, present status.

IX. REFERENCES

List at least four individuals who have knowledge of your teaching ability, training, and character

Name	Address	Phone Number	Position

Name of present Superintendent:
Name of present Principal:
May we contact the above individuals for references?	Yes No
Why do you want to leave your present position?
Present Salary:
Least salary you would accept:
When would you be available to work?
Indicate days/hours which would be convenient for an interview:

X. REMARKS

Please provide a brief explanation of your goals and philosophy of education and any other items you would want to be considered that are not part of this application.

XI. PUBLICATIONS, ACCOMPLISHMENTS & HONORS

XII. ACCEPTANCE OF TERMS

By checking this box, I affirm that all of the above information is correct and fully authorize an investigation to confirm the validity thereof. Furthermore, I understand that any misrepresentation or omission of facts will result in immediate dismissal.