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PUTNAM COUNTY CHARTER SCHOOL SYSTEM
Application Procedures
Application Form
1. You must provide all information requested on the application form. Please do not write “See Resume.”
2. Three personal reference forms are required on all applicants. If you are an experienced teacher, your references
must include current, or most recent, supervisor or evaluator.
3. Official undergraduate and graduate transcripts are required before an offer of employment can be finalized. You
may submit unofficial copies of your transcript pending receipt of official transcripts.
4. Only United States Citizens and aliens lawfully authorized to work in the United States may be hired and will be
verified using E-verify.
5. Completing an application does not guarantee employment. Transcripts, Teacher Reference Checks, Teaching
Certificates, etc. are kept on file for six months.
6. A criminal record check by fingerprinting is required by Georgia State Law prior to employment with a county
board of education.
RETURN YOUR APPLICATION FOR EMPLOYEMENT TO:
Putnam County Charter School System
Human Resources Office
158 Old Glenwood Springs Road
Eatonton, GA 31024
Revised 3/2012
Putnam County Charter School System
Application for Certified Educational Position
(Including Teacher, Administrator or Other Certified Position)
Instructions: Please complete all sections accurately.
Date: ____________________________ Date available to begin employment: _________________________________________________
Applying for a position as: ____ Early Childhood Teacher ____ Middle School Teacher ____ Secondary Teacher
____ Administrator ____ Counselor ____ Media Specialist
____ Other (please specify) ____________________________________________
1. PERSONAL INFORMATION
Applicant’s Name _______________________________________________________________________________________________________
Last First Middle
Address ________________________________________________________________________________________________________________
Street City State Zip Code
Contact Information _______________________________________________________________________________________________________
Home Phone Work Phone Cell Phone Email Address
In order to provide statistical information relative to applications for employment, we are requesting that you voluntarily complete the following
information:
Gender: ____Male ____ Female
Ethnicity: ___American Indian or Alaskan Native ___Asian or Pacific Islander ___Black, Not of Hispanic Origin ___Hispanic ___White
2. GEORGIA CERTIFICATION INFORMATION
Do you have a current Georgia Certificate? ____Yes ____No
If Yes: ___________________ _____________________________________________________ __________________ _____________________
Type List all Certification Field(s) Expiration Date Georgia Certificate ID#
If No: Has an application been made? ___Yes ___No (Please enclose copies of Georgia Professional Standards Commission correspondence)
Do you hold an out-of-state certificate? ___Yes ___No ______ _____________________________ ___________________
State Certificate Field(s) Expiration Date
3. EDUCATION
College or University Major Minor Degree Date Degree Type
Revised 3/2012
Putnam County Charter School System
Application for Certified Educational Position
4. INTERNSHIPS/STUDENT TEACHING EXPERIENCE
Number Of
School and Location Date(s) Grade(s) Subject Supervising Teacher
Weeks
5. EMPLOYMEMT EXPERIENCE
Are you currently employed? ____Yes ____No
If yes, may current employer be contacted for validation? ____Yes ____No
If no, state reason(s): _____________________________________________________________
A. EDUCATION EMPLOYMENT EXPERIENCE
Report all teaching and administrative experience in chronological order. Indicate continuous experience in one system on one line. A minimum of
120 days under contract is necessary for credit for a year’s service. Do not report substitute teaching or working in a non-certified position such as a
paraprofessional.
Name of School Address Dates Total Grade/Subject Taught
(To-From) Years
B. MILITARY SERVICE EXPERIENCE
Military Service Branch Dates of Service Highest Rank Type of Discharge
(Active Duty Only)
C. EXPERIENCE OTHER THAN SCHOOL AND MILITARY SERVICE
Employer Address Dates (To-From) Type of Work
Revised 3/2012
6. OTHER INFORMATION
Are you currently under contract with another school district? ___Yes ___No
If Yes: Date Contract Expires ___________ Name of School System _____________________________________
List special honors or awards of distinction you have received while in college, in your profession or in your community:
______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
List professional clubs or organizations of which you are a member: ________________________________________________________________
_______________________________________________________________________________________________________________________
7. REFERENCES
List three (3) former supervisors or college professors from whom you will request references. (Forms are in the application package). If you are an
experienced teacher or administrator, include your former superintendents, principals and supervisors. If you are a beginning teacher, include college
professors, student teaching supervisor, and/or major professors. Do not include neighbors, friends or relatives.
Name and Title Mailing Address City, State and Zip Phone Number
8. BACKGROUND INFORMATION
Each of the following questions must be answered with a “yes” or “no.” If any answer is “yes,” please attach an
Yes No
explanation and include final dispositions of investigations.
1. Have you ever failed to have a contract renewed?
2. Have you ever been dismissed from employment with a school system, asked to resign, not been reappointed, not
offered another contract or resigned in lieu of dismissal?
3. Have you ever surrendered a teaching certificate/credential/license/permit, or had one denied, revoked or suspended,
or is any investigation or adverse action now pending against you?
4. Have you ever been found guilty, entered a plea of nolo contendere, been granted first offender treatment without
adjudication of guilt, been placed under a court order whereby any adjudication or sentence was otherwise withheld
for any misdemeanor involving moral turpitude or for any felony, or is any charge currently pending against you,
including issuance of a bad check? (Excluding minor traffic offenses.) Please note: Driving While Intoxicated
(DWI), Driving Under the Influence (DUI), and similar charges are NOT considered minor traffic offenses.
5. Have you ever been investigated for any act of alleged discrimination including: discrimination on account of race,
color, gender, religion, age, national origin, or handicapping condition?
6. Have you ever received a dishonorable discharge from the armed services?
7. Have you ever been investigated for allegations of sexual harassment?
8. Have you ever been accused and investigated for a crime of child abuse or physical abuse?
9. Are you legally authorized to work in the United States as a United States Citizen or a non-citizen with employment
authorization? (Proof of eligibility will be required before you can begin to work)
10. Are you or have you ever been on a HIB or J1 Visa?
11. If yes to above question, do you need a sponsor?
Revised 3/2012
9. AUTOBIOGRAPHY
Please write in your own handwriting a one page response to the following question: Why are you uniquely qualified for this position and why should
you be selected over other candidates?
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Revised 3/2012
Putnam County Charter School System
Application for Certified Educational Positions
SIGNATURE
By filing an application for employment with the Putnam County Board of Education, I understand that any misrepresentation or omission of facts on
the application may be cause for termination. If employed, I agree to abide by all the policies set forth by the Putnam County Board of Education. As
an applicant, I understand that I am subject to a criminal background check, which includes the requirement of fingerprinting.
Signature of Applicant _________________________________________________ Date ___________________________
Submit application or mail completed application to the following address:
Putnam County Charter School System
Human Resources Office
158 Old Glenwood Springs Road
Eatonton, GA 31024
The Putnam County Charter School System does not discriminate on the basis of color, race, national origin, sex, age, marital status, religion,
handicap, or disability in education programs, activities, or employment practices. Inquiries or concerns regarding Title VI, or Title IX should be
addressed to the following individuals:
Bessie M. Brown Laura Melton
Title IX Coordinator Title VI/ADA Coordinator
Putnam County Charter School System Putnam County Charter School System
158 Old Glenwood Springs Road 158 Old Glenwood Springs Road
Eatonton, GA 31024 Eatonton, GA 31024
Revised 3/2012
Putnam County School System
Confidential Reference Form for Certified Employees
Section I – To be completed by the applicant and forwarded to confidential reference for completion.
I acknowledge and agree that the information provided on this form will be regarded as confidential communication between the reference source
and Putnam County Charter School System. I further acknowledge and agree that such information will not be shared with me and that my signature
below waives any rights I might have now or in the future to examine, copy, or otherwise access this information.
_____________________
Date
_____________________________________________________________________________________________________________________
Last Name First Name Middle Name
Applying for position of: _________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Section II – To be completed by confidential reference and forwarded to Putnam County Charter School System (see address below).
The individual identified above is applying for employment with Putnam County Charter Schools and has listed you as a reference. Your candid
evaluation will help ensure the interests of students, the community, the district, and the applicant are properly addressed. Please note that references
are regarded as confidential and that the applicant has waived any right to access them now or in the future. Please mark in the appropriate column
your assessment of the applicant in each factor you believe you have adequate knowledge.
Qualities Superior Above Average Below Not
(Top 5%) Average (Next 50%) Average Observed
(Next 20%) (Lower 25%)
Supports the organization’s mission and beliefs
Has high expectations of all students/others
Provides quality, engaging work to students/others
Believes high achievement is attainable by all
Monitors progress and modifies instruction as needed
Exhibits leadership qualities and initiative
Demonstrates continuous professional growth
Embraces change as opportunity for growth
Communicates effectively and professionally
Demonstrates trustworthiness and loyalty
Effective team leader
Exhibits positive attitude, tact, and self-control
Demonstrates competence in area of expertise
Demonstrates competence in classroom/organizational management
Adheres to policies, procedures, and rules
Timeliness, attendance and punctuality
Overall evaluation
Your name (please print): ___________________________________________________ Title: __________________________________________
If the applicant was an employee: Name of business/organization and location: ________________________________________________________
Relationship to the applicant: _______________________________________ Length of time you have known the applicant: ___________________
Would you rehire this applicant? Yes _____ No ____Would you hire this applicant to work with your children? Yes ___ No___
Should we telephone you for additional information? Yes _____ No_____ Preferred Contact Number: ________________
Other comments regarding the applicant’s strengths and areas needing improvement: ___________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Signature Date Email Address
________________________________________________________________________________________________________________________
Street Address City State Zip Code
Send completed form to: Putnam County Charter School System - Human Resources, 158 Old Glenwood Springs Rd. Eatonton, GA 31024
Revised 3/2012
Putnam County School System
Confidential Reference Form for Certified Employees
Section I – To be completed by the applicant and forwarded to confidential reference for completion.
I acknowledge and agree that the information provided on this form will be regarded as confidential communication between the reference source
and Putnam County Charter School System. I further acknowledge and agree that such information will not be shared with me and that my signature
below waives any rights I might have now or in the future to examine, copy, or otherwise access this information.
_____________________
Date
_____________________________________________________________________________________________________________________
Last Name First Name Middle Name
Applying for position of: _________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Section II – To be completed by confidential reference and forwarded to Putnam County Charter School System (see address below).
The individual identified above is applying for employment with Putnam County Charter Schools and has listed you as a reference. Your candid
evaluation will help ensure the interests of students, the community, the district, and the applicant are properly addressed. Please note that references
are regarded as confidential and that the applicant has waived any right to access them now or in the future. Please mark in the appropriate column
your assessment of the applicant in each factor you believe you have adequate knowledge.
Qualities Superior Above Average Below Not
(Top 5%) Average (Next 50%) Average Observed
(Next 20%) (Lower 25%)
Supports the organization’s mission and beliefs
Has high expectations of all students/others
Provides quality, engaging work to students/others
Believes high achievement is attainable by all
Monitors progress and modifies instruction as needed
Exhibits leadership qualities and initiative
Demonstrates continuous professional growth
Embraces change as opportunity for growth
Communicates effectively and professionally
Demonstrates trustworthiness and loyalty
Effective team leader
Exhibits positive attitude, tact, and self-control
Demonstrates competence in area of expertise
Demonstrates competence in classroom/organizational management
Adheres to policies, procedures, and rules
Timeliness, attendance and punctuality
Overall evaluation
Your name (please print): ___________________________________________________ Title: __________________________________________
If the applicant was an employee: Name of business/organization and location: ________________________________________________________
Relationship to the applicant: _______________________________________ Length of time you have known the applicant: ___________________
Would you rehire this applicant? Yes _____ No ____Would you hire this applicant to work with your children? Yes ___ No___
Should we telephone you for additional information? Yes _____ No_____ Preferred Contact Number: ________________
Other comments regarding the applicant’s strengths and areas needing improvement: ___________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Signature Date Email Address
________________________________________________________________________________________________________________________
Street Address City State Zip Code
Send completed form to: Putnam County Charter School System - Human Resources, 158 Old Glenwood Springs Rd. Eatonton, GA 31024
Revised 3/2012
Putnam County School System
Confidential Reference Form for Certified Employees
Section I – To be completed by the applicant and forwarded to confidential reference for completion.
I acknowledge and agree that the information provided on this form will be regarded as confidential communication between the reference source
and Putnam County Charter School System. I further acknowledge and agree that such information will not be shared with me and that my signature
below waives any rights I might have now or in the future to examine, copy, or otherwise access this information.
_____________________
Date
_____________________________________________________________________________________________________________________
Last Name First Name Middle Name
Applying for position of: _________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Section II – To be completed by confidential reference and forwarded to Putnam County Charter School System (see address below).
The individual identified above is applying for employment with Putnam County Charter Schools and has listed you as a reference. Your candid
evaluation will help ensure the interests of students, the community, the district, and the applicant are properly addressed. Please note that references
are regarded as confidential and that the applicant has waived any right to access them now or in the future. Please mark in the appropriate column
your assessment of the applicant in each factor you believe you have adequate knowledge.
Qualities Superior Above Average Below Not
(Top 5%) Average (Next 50%) Average Observed
(Next 20%) (Lower 25%)
Supports the organization’s mission and beliefs
Has high expectations of all students/others
Provides quality, engaging work to students/others
Believes high achievement is attainable by all
Monitors progress and modifies instruction as needed
Exhibits leadership qualities and initiative
Demonstrates continuous professional growth
Embraces change as opportunity for growth
Communicates effectively and professionally
Demonstrates trustworthiness and loyalty
Effective team leader
Exhibits positive attitude, tact, and self-control
Demonstrates competence in area of expertise
Demonstrates competence in classroom/organizational management
Adheres to policies, procedures, and rules
Timeliness, attendance and punctuality
Overall evaluation
Your name (please print): ___________________________________________________ Title: __________________________________________
If the applicant was an employee: Name of business/organization and location: ________________________________________________________
Relationship to the applicant: _______________________________________ Length of time you have known the applicant: ___________________
Would you rehire this applicant? Yes _____ No ____Would you hire this applicant to work with your children? Yes ___ No___
Should we telephone you for additional information? Yes _____ No_____ Preferred Contact Number: ________________
Other comments regarding the applicant’s strengths and areas needing improvement: ___________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Signature Date Email Address
________________________________________________________________________________________________________________________
Street Address City State Zip Code
Send completed form to: Putnam County Charter School System - Human Resources, 158 Old Glenwood Springs Rd. Eatonton, GA 31024
Revised 3/2012
