ADMINISTRATIVE APPLICATION by FgAD7k

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									                                                                          NCLB COMP ______________
                                                                          REVIEWED _______________
                                                                          INTERVIEWED ___________
15579 8th Street                                                          SENT LETTER ____________
Victorville, CA 92395                                                     OFFER CONTRACT ________
                                                                                      CLASS ______
(760) 245-1691                                                                         STEP ______
www.vesd.net


                        APPLICATION FOR CERTIFICATED EMPLOYMENT
                                  SPEECH PATHOLOGIST
   I. PERSONAL INFORMATION
LAST                                  FIRST                                        HOME PHONE
                                                                    MI:
NAME:                                 NAME:
MAILING                                                       ST/                  CELL PHONE
            STREET                    CITY
ADDRESS:                                                      ZIP
PHYSICAL                                                      ST/                  EMAIL
            STREET                    CITY
ADDRESS:                                                      ZIP


   II. POSITION PREFERENCES
     (Check)                      (Prioritize)                            (Yes or No)
     Classroom Teacher            Kindergarten                            Traditional (Sept-Jun)
     Bilingual                    Grades 1-2                              Year Round (Jul-Jun)
     Special Education            Grades 3-4
     Speech                       Grades 5-6
Are you currently employed?                        Date available

  III. PROFESSIONAL REFERENCES (include your current or most recent supervisor)
                                              DISTRICT OR COLLEGE
NAME                 POSITION                 CITY AND STATE                TELEPHONE


                                                 DISTRICT OR COLLEGE
NAME                       POSITION              CITY AND STATE              TELEPHONE


                                                 DISTRICT OR COLLEGE
NAME                       POSITION              CITY AND STATE              TELEPHONE


                                                 DISTRICT OR COLLEGE
NAME                       POSITION              CITY AND STATE              TELEPHONE



PLEASE SUBMIT YOUR PLACEMENT FILE OR THREE LETTERS OF RECOMMENDATION
    VII. ADDITIONAL INFORMATION
                                                                                                                                 YES        NO
    A. HAVE YOU EVER HAD A CREDENTIAL SUSPENDED OR REVOKED?
       If yes, please explain where and why
    B. HAVE YOU EVER BEEN CONVICTED OF A FELONY?
       Conviction will not necessarily disqualify an applicant from employment
    C. HAVE YOU EVER LEFT A TEACHING POSITION PRIOR TO THE EXPIRATION OF A
       CONTRACTUAL AGREEMENT?
       If yes, please explain where and why
    D. ARE YOU RELATED TO ANY PRESENT EMPLOYEE OF THIS DISTRICT?
       If yes, give name and position
    E. HAVE YOU EVER BEEN EMPLOYED BY THIS DISTRICT?
       If yes give location and date employed.
    F. ARE YOU CURRENTLY UNDER CONTRACT?
       If yes, give location and date of expiration.
    G. DO YOU OBJECT TO HAVING YOUR PRESENT EMPLOYER CONTACTED?
    H. ARE YOU A CURRENT MEMBER OF A CALIFORNIA RETIREMENT SYSTEM? (STRS)
                                                                                                                     (PERS)
    I. HAVE YOU BEEN ISSUED AN NCLB CERTIFICATE OF COMPLIANCE?
    J. DO YOU HOLD NATIONAL BOARD CERTIFICATION?
    K. CAN YOU PROVIDE DOCUMENTS TO VERIFY YOUR IDENTITY AND
       AUTHORIZATION TO WORK IN THE UNITED STATES?
         Documents may include, but are not limited to Birth Certificate or Social Security Card and Driver’s License;
         Citizenship or Naturalization certificate; Passport or Alien registration card; other approved documents.


CREDENTIALS HELD – PLEASE PROVIDE COPIES
Name of Credential       Subject/Authorization                                                     Date Issued/State           Expiration Date




CREDENTIALS ANTICIPATED
Name of Credential   Qualified Now/Or Anticipated Completion Date                                                   Institution Name




                                                                                                          Yes       No                    Yes    No
Have you taken the following:                                                       CBEST                                     PASSED
SUBJECT MATTER EQUIVALENCY EXAM                                             CSET/MSAT/NTE                                     PASSED

CERTIFICATION OF APPLICATION
Read Before Signing:
I certify that the statements I have made in this application are true. Further, I authorize the Victor Elementary
School District to verify the foregoing and any other information which might assist the District to determine my
qualifications for employment. I hereby release the Victor Elementary School District and my former employers
from any liability which may result from such investigations. If, upon investigation, anything in the application is
found to be untrue, I understand that any false statements of material facts can cause forfeiture on my part to any
employment with the Victor Elementary School District.
Date:                         Legal Name:                                                   Signature

VICTOR ELEMENTARY SCHOOL DISTIRCT IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER:
The law prohibits discrimination on the basis of sex, race, color, religious creed, national origin, ancestry, physical handicap,
medical condition or age in its employment practices. Victor Elementary School District also maintains a smoke-free
workplace.
    IV. EDUCATION
       Name of Institution                     Location                From          To           Degrees Earned            Major
                                              (City/State)            (Date)       (Date)          Date Earned




Number of semester units of graduate work beyond BA or BS degree             Number beyond MA or MS
                                                                   (1 QUARTER UNIT = 2/3 SEMESTER UNIT)
Graduate work is defined by a given college or university acceptable toward meeting requirements for an advanced degree or
credential and taken after the date the BA/BS degree is received. Transcripts of all college and university work are required before a
pay warrant can be issued.

    V. EXPERIENCE
List only experience applicable to position for which you are applying, the most recent first
STUDENT TEACHING EXPERIENCE:
                                                                 Dates          Grades          Master Teacher          College
District                       City/State
                                                                From-To         Taught                                  Supervisor


TEACHING EXPERIENCE UNDER CONTRACT: (Do Not List Substitute Teaching)
                                                       Dates          Grades      Immediate
District                  City/State                                                                   Reason for Leaving
                                                      From-To         Taught      Supervisor




                                        TOTAL YEARS TEACHING EXPERIENCE UNDER CONTRACT
EDUCATIONAL EXPERIENCE OTHER THAN CONTRACT TEACHING: (Include part-time and Substitute Teaching here)
                                                                                                                        Dates
District                       City/State                     Type of Work
                                                                                                                       From-To




EXPERIENCE OTHER THAN TEACHING: (Optional)
                                                                                                                        Dates
District                       City/State                     Type of Work
                                                                                                                       From-To
    VI. QUESTIONS
Please respond to the following questions in the space provided. (Your own handwriting is preferred.)

    1. What do you consider to be some of your highest motivations for choosing to become a Speech
       pathologist?




    2. What kind of relationship do you establish and maintain with students? Why?




    3. What do you most want to achieve in the kind of relationships you build with students?




    4. What do you especially think about as you begin to design independent or small group lessons?




    5. What would a supervisor observe when you are providing services to students?




    6. How do you want students to be different as a result of their experiences with you?




    7. What major strategies do you most employ to deliver instruction to make a difference in the lives of
       students?




    8. Why are you interested in Victor Elementary School District?

								
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