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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

				
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