Get documents about "CERTIFICATED APPLICATION
Shared by: HC120730004312
-
Stats
- views:
- 0
- posted:
- 7/29/2012
- language:
- pages:
- 9
Document Sample
30429 S GRAYS HILL RD – COLTON OREGON 97017
503.824.3535
LICENSED EMPLOYEE APPLICATION
EQUAL OPPORTUNITY
The Colton School District is an equal opportunity employer and complies with all applicable state and federal
statutes and regulations in employment and school district programs. Equal employment opportunity and
treatment shall be provided in recruiting, hiring, retaining, transferring, promoting and training of all employees
regardless of the individual’s race, religion, color, sex, sexual orientation, national origin, marital status, age or
disability
DRUG-FREE WORKPLACE
The Colton School District is committed to maintaining a drug-free workplace and strictly complies with the
Drug-Free Workplace Act of 1988 and the Drug-Free Schools and Communities Act of 1989.
In accordance with District policy, smoking and the use of all tobacco products is prohibited on all District
property.
NAME (Last) (First) (Middle) PHONE #
APPLICATION PROCEDURES
The Colton School District is interested in you as a candidate. To help us with the application process, we request that you follow these procedures:
APPLICATION: For your application to be considered, it must be fully completed. Your application must also include a cover letter, résumé, and
three letters of recommendation from those who have supervised your teaching. Unofficial transcripts and a copy of your current
teaching license are required.
INTERVIEWS: Candidates will be selected for interviews when specific vacancies occur in areas of qualification.
EMPLOYMENT OFFER: Official offers of employment will be made by the Superintendent of the Colton School District.
LICENSURE: A valid Oregon teaching license for the assignment offered to an applicant must be on file in the District office prior to the
beginning date of the contract.
TRANSCRIPTS: Upon the acceptance of an offer of employment, the applicant must provide official transcript(s) of all college preparation.
SUBSTITUTE TEACHING: Substitute teaching is based on areas of need. Placement on the substitute list occurs only after registration with both the
Clackamas County ESD and the Colton School District Human Resources Department.
PERSONAL INFORMATION · Required
Have you ever:
A. left any school-related employment, voluntarily or involuntarily, while the subject of an inquiry, review or investigation of alleged misconduct, or alleged
violation of professional standards or conduct, or when you had reason to believe such investigation was imminent? Yes No
B. failed to complete a contract for educational services in any educational position, or for any alleged misconduct or alleged violation of professional
standards of conduct, been placed on leave by your employer or left employment prior to the end of the contract term? Yes No
C. had a professional certificate, credential or license (of any kind) revoked or suspended or have you been placed on probationary basis for any alleged
misconduct or alleged violation of professional standards of conduct?.......................................................................... Yes No
D. been denied a professional license for which you applied, or granted a professional license on a conditional or probationary basis for any alleged
misconduct or alleged violation of professional standards of conduct?.......................................................................... Yes No
E. surrendered a professional license of any kind before its expiration? ........................................................................... Yes No
F. been disciplined by a public agency responsible for licensure of any kind, including, but not limited to, educational licensure? Yes No
G. been convicted or been granted conditional discharge by any court for: (a) any felony, (b) misdemeanor, or (c) any major traffic violation, such as:
driving under the influence of intoxicants or drugs; reckless driving; fleeing from or attempting to elude a police officer, driving while your license was
suspended, revoked or used in violation of any license restriction; failure to perform the duties of a driver/witness at an accident? Yes No
H. been arrested or cited for any offense listed in question (G) above which is still pending in court? .............................. Yes No
I. entered a plea of Guilty or No Contest relative to any charge for an offense listed in question (G)? ............................. Yes No
J. had any civil judgment or other court order entered against you resulting from abuse, assault, battery, harassment, intimidation, neglect, stalking or
other threatening behavior toward other persons? ........................................................................... Yes No
Are you currently the subject of an inquiry, review or investigation for alleged misconduct or alleged violation of professional standards of conduct? Yes No
(If you answered yes to any of the above, please explain.)
PLEASE READ AND SIGN
I hereby declare that the facts set forth on this application for employment are true and complete to the best of my
knowledge. I understand that any omissions on this application may prevent my application from being evaluated by the
District. I understand that any misrepresentations, falsifications, or omissions on this application or on any other documents
submitted to the District in the course of my employment will be sufficient cause for this application not to be considered by
the District. I further understand that, if employed, misrepresentations, falsifications, or omissions on this application or on
any other documents submitted to the District in the course of my application for employment shall be considered sufficient
cause for immediate dismissal.
SIGNATURE OF APPLICANT*: Date:
*If submitting application electronically, your typed name in the field above is accepted as your signature.
APPLICANT PLEASE COMPLETE
Please indicate why you are interested in working in the Colton School District.
(Response may be typed or handwritten)
PLEASE READ AND SIGN
I hereby certify that I have read the qualifications for the position for which I am applying contained within the District’s job posting for that position. I
further certify that I am able to perform each and every requirement of that position, with or without reasonable accommodation.
Signature of Applicant*: Date
*If submitting application electronically, your typed name in the field above is accepted as your signature.
PLEASE READ AND SIGN
I hereby grant to the District or its agent permission to obtain information regarding my criminal records. I further authorize the District or its agent to
check the references I have listed on this application form, or have otherwise provided to the District, to obtain information from prior employers and
educational institutions. I authorize the District to take any and all actions necessary to investigate and verify any information provided in my application
for employment, and to obtain information relevant to evaluating my qualifications and fitness for a teaching position. I authorize my listed references,
past employers and educational institutions, and anyone else contacted by the District, to provide such information to the District as is necessary to
evaluate my fitness for employment. I hereby release the District and all persons providing information to the District from any liability whatsoever for
obtaining and providing that information, regardless of the results. If hired, and upon leaving the employment of the District, I authorize the District or its
agent to provide information to prospective employers that is relevant to my fitness as a teacher.
Signature of Applicant*: Date
*If submitting application electronically, your typed name in the field above is accepted as your signature.
PLEASE COMPLETE THE NEXT PAGE OF THIS APPLICATION
The information on all items below should be as complete and accurate as possible as it is used as the preliminary basis for determining salary. Please do not refer to your résumé.
EDUCATIONAL BACKGROUND
DATES DEGREE &
NAME OF SCHOOL LOCATION MAJOR MINOR G.P.A.
Inclusive Date Rec'd
High School
Undergraduate
College or
University
Post Graduate
College Work
TEACHING EXPERIENCE
List most recent experience first. Include only those experiences for which a teaching license was required. Pease do not include substitute experience.
Other job related experiences should be listed on your résumé.
DATES No. of SUBJECTS AND FULL PART REASON FOR LEAVING OR
DISTRICT/LOCATION NAME OF SCHOOL
From To Years GRADES TAUGHT TIME TIME WISHING TO LEAVE
STUDENT TEACHING EXPERIENCE: If your only teaching experience to date has been student teaching, please describe on the line below.
REFERENCES Give three references including superintendents and principals who have first-hand knowledge of your character, personality, scholarship and teaching ability.
PHONE
NAME CURRENT ADDRESS POSITION/DISTRICT
WORK HOME
LICENSED EMPLOYEE APPLICATION SUPPLEMENT
Colton School District
30429 S Grays Hill Rd
Colton, OR 97017
503-824-3535
Position Applying for Date
Name
Last First Middle
Address
Street City State Zip
Phone No. E-mail Address
Date of Availability
Are you registered with edZapp? yes no
Do you hold an Oregon Teaching License? yes no in process
(If yes, please include a copy with this application)
Endorsement(s)
Position Preferences:
Elementary Secondary
Kindergarten Grades 6-8 (Middle School)
Grades 1-3 Grades 9-12 (High School)
Grades 4-5
Blended Classrooms
Full Time Part Time
* Substitute
*If checked, please call 503-824-3535 to find out how to register to become a substitute.
Please call Human Resources at the above number if you have any questions about filling out this application.
HR 02/08
Colton School District
APPLICANT
EQUAL EMPLOYMENT OPPORTUNITY
y
This information is collected only for Equal Employment Opportunity reporting purposes. This form will be
physically separated from your other personnel materials.
Part One
Ethnicity: Are you Hispanic or Latino? – A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture regardless of race.
Yes or No
Part Two
Race: Select one or more races from these five categories:
American Indian/Alaskan Native (not Hispanic or Latino) – A person having origins in any
of the original peoples of North and South America (including Central America), and who
maintain tribal affiliation or community attachment.
Asian (not Hispanic or Latino) – A person having origins in any of the original people of the
Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia,
China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and
Vietnam.
Black or African American (not Hispanic or Latino) – A person having origins in any of the
black racial groups of Africa.
Native Hawaiian or other Pacific Islander (not Hispanic or Latino) – A person having
origins in any of the originals peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White – A person having origins in any of the original peoples of Europe, the Middle East,
or North Africa.
Sex: Female Male
Date of Birth: / /
Equal Opportunity:
The Colton School District is an equal opportunity employer and complies with all applicable state
and federal statutes and regulations in employment and school district programs. Equal
employment opportunity and treatment shall be provided in recruiting, hiring, retaining,
transferring, promoting and training of all employees regardless of the individual’s race, religion,
color, sex, sexual orientation, national origin, marital status, age or disability.
I was given the opportunity to complete this form.
Printed Name:
Signature: Date: / /
*If submitting application electronically, your typed name in the field above is accepted as your signature
Colton School District
Disclosure Release
To: Human Resources
School District/Education Provider
Street Address
City, State, Zip
The applicant named below is under consideration for employment in our district. This individual has previously
been employed with your organization. As a former employer, we request you provide the information requested on
this form within 20 business days pursuant to ORS 339.374.
Applicant Name (First, Middle, Last)
Dates of Employment No record of employment
Positions Held
I authorize you to release to the district listed below, all information related to any substantiated reports of child
abuse, sexual conduct or crimes listed in ORS 342.143. I release the above employer and employees acting on
behalf of the employer from any liability for providing information described in the document.
Applicant Signature Date
This section to be completed by previous employer only.
The employee was was not the subject of a substantiated report of child abuse or sexual conduct related to the
applicant’s employment with the education provider.
Dates of any substantiated reports:
Please attach the definitions of child abuse and sexual conduct used by the District when the education
provider determined that any reports were substantiated and the standards used by the District to determine
whether any reports were substantiated.
If the employee was convicted of a crime listed in ORS 342-143, please send the employee’s disciplinary
records as required by ORA 339.388 (7).
Former Employer Representative Signature Date
Printed Name Job Title
Return completed information to: Colton School District – HR
Fax: 503-824-3530 30429 S Grays Hill Rd
Email: weningen@colton.k12.or.us Colton, OR 97017
Definition of Sexual Conduct
“Sexual conduct” means any verbal or physical conduct by a school employee that:
A. Is sexual in nature;
B. Is directed toward a kindergarten through grade 12 student,
C. Has the effect of unreasonably interfering with a student’s educational performance; and
D. Creates an intimidating, hostile or offensive educational environment.
Description of conduct that may constitute sexual conduct::
Please note that this is not an exhaustive list.
1. A student older than [second grade] sitting on a staff member’s lap
2. Holding hands with a student older than [second grade]
3. Staff performing back rubs on a student
4. Kissing students
5. Touching students frequently
6. Commenting on students’ bodies or appearance in a sexual manner
7. Exchanging romantic gifts or communications with a student
8. Showing pornography and obscene or suggestive photos to the student
9. Videotaping or photographing a student in revealing or suggestive poses
10. Discussing/writing about sexual topics unrelated to curriculum with students, making sexual jokes,
gestures, pictures, and innuendos or engaging in inappropriate banter with students (e.g., discussion of
student’s dating behavior)
11. Sharing your own sexual exploits or marital difficulties
12. Intentionally invading the student’s privacy (e.g. walking in on him/her in the bathroom
intentionally)
13. Going to the student’s home without parent supervisions
14. Using e-mail, text-messaging, or instant messaging to discuss sexual topics with individual
students
15. Dating students
APPLICANT RELEASE AND AUTHORIZATION
FORM
I hereby certify that my application contains no misrepresentations of
falsifications and that the information given is true and complete to the best of my knowledge and belief. I
understand any misrepresentation of omission of facts called for in my application may prevent my
application from being evaluated or referred for positions, may be cause for cancellation of the application
and/or dismissal from employment with the Colton School District.
As part of my application for employment, I hereby consent to and authorize the release of any and all
information to the Colton School District, which may be considered in evaluating my qualifications for
employment. I therefore release all parties persons connected with any request for information from all
claims, liability and/or damages for whatever reasons arising out of furnishing such information.
I authorize the Colton School District, where I have completed an employment application, to check my
references, to obtain information provided in my employment application, and to obtain information
relevant to evaluating my qualifications and fitness for a teaching position or other employment with the
District. I authorize my listed references, past employers and educational institutions, and anyone else who
has information about my work history, education, qualifications, or fitness to provide such information to
the Colton School District for which I have completed an employment application.
I authorize the Colton School District to obtain information about my criminal records, I authorize all
governmental agencies to provide information about my criminal records to the school district.
Fingerprinting and a criminal records check for each successful applicant are required by Oregon law and
District policies. Any offer of employment is contingent on clearance for continued employment by the
Oregon State Department of Education or Teacher Standards and Practices Commission.
I authorize the Colton School District to obtain from any current and/or former employers the following
information: A0 the dates of employment; B) whether I was the subject of any substantiated reports(s) of
child abuse or sexual conduct related to my employment; C) the dates of any such substantiated reports D)
the definition(s) of child abuse and sexual conduct used by the employer when the employer determined
that any reports were substantiated; E) the standards used by the employer to determine whether any reports
were substantiated; and F) any disciplinary records required to be released as provided by ORS 339.378.
I release the school district and all person providing this information to the school district from any liability
whatsoever for obtaining and providing that information, regardless of the results.
Printed First, Middle and Last Name: _______________________________________________
List Other Names Previously Used: _________________________________________________
Applicant’s Signature: ________________________________ Date: ______________________
