DIVISION OF INSTRUCTIONAL SUPPORT SERVICES
REGIONAL SUMMER SCHOOL
Paula H. Klingelhoefer, Executive Director
31 Lee Avenue
Wheatley Heights, NY 11798
Regional Summer School 2012
Thank you for your interest in a n instructional position at Western Suffolk BOCES for the 2012 summer
session. Please read the attached application carefully and complete all sections fully. You must attach
your résumé and certification(s). Failure to do so may result in your not being selected for a summer school
Please note the information outlined below that relates to your potential employment.
Completed applications must be returned by May 1, 2012, to:
Paula Klingelhoefer, Executive Director, Division of Instructional Support Services
31 Lee Avenue
Wheatley Heights, New York 11798
Effective July 1, 2001, all new employees must be fingerprinted. If you worked for BOCES
during the summer school 2002, this will not be necessary. If you have been fingerprinted in another
school district, you can provide us with a release to receive this clearance and re-fingerprinting will not
be required. If you need to be fingerprinted, please read the attached information sheet carefully and
follow all instructions.
Summer School Calendar Formatted: Indent: Left: 0"
Program dates for Regional Summer School 2012 are July 9, 2012 and end Aug. 17, 2012 for a total of 26 days. Formatted: Justified, Indent: Left: 0"
School will be in session Monday through Thursday for the first four weeks and Monday through Friday for the
last two weeks. The program will operate for 24 daily instructional periods consisting of 113 minutes plus two
New York State testing days. There will be a mandatory summer school planning meeting for all
instructional staff on Friday, June 29, 2012. It is noted that some staff may be required to work beyond
August 17 to complete examination scoring and program reporting.
Attendance Formatted: Font: Bold
It is expected that all employees will work every day of the program. There are no excusable Formatted: Indent: Left: 0"
Additional Forms Formatted: Indent: Left: 0"
All employees must fully complete the attached Instructional application and the NYS Retirement
System questionnaire. The additional required steps include:
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Submit a copy of your résumé plus all appropriate certification(s)
Submit a copy of New York State Teachers’ membership card or annual statement indicating Formatted: Font: Bold
membership number and date of membership.
Review the Fingerprinting information and follow all instructions. Formatted: Bulleted + Level: 1 + Aligned at:
0.25" + Tab after: 0.5" + Indent at: 0.5"
If not a citizen of the U.S., provide original proof of identification and original proof of authorization
to work in the U.S.
We hope to notify successful candidates by June 11, 2012, although employment is contingent upon
student enrollment. Please do not call the summer school office for application status.
TO: Instructional – Regional Summer School
FROM: Western Suffolk BOCES Personnel Department
SUBJECT: Fingerprinting Instructions
As a result of the July 1, 2001 SAVE Legislation affecting all schools in New York State, all new
employees must be fingerprinted for a criminal history background check in order to be cleared for
employment at a school.
For those employees that require fingerprinting, you will need to have access to a computer and
printer in order to complete the state required fingerprinting paperwork and print your payment
confirmation. If you do not have access to a computer, please visit your local library.
All fingerprinting for Instructional Regional Summer School employees will be handled by:
Western Suffolk BOCES
507 Deer Park Road
Dix Hills, NY 11746
Go to the website www.wsboces.org/employment, click on the logo:
Under Step 1 – Click Self Register create a login account to access the system. You will need a
credit card during this process to make payment for the New York State fingerprinting fee (if
you do not possess a credit card, you can purchase a pre-paid Master Card or Visa at a local
store). The SED fee is $94.25. You must follow all directions carefully as you will be
prompted to print a payment confirmation. You must bring this payment confirmation with
you in order to be fingerprinted.
Upon arrival to Western Suffolk BOCES, proceed to the Treasurer’s Office to pay a $20.00 Western
Suffolk BOCES fingerprinting processing fee. We accept cash, check or money order (payable to
Western Suffolk BOCES). You will be given a receipt for this payment.
PLEASE BRING THE FOLLOWING TO YOUR FINGERPRINTING APPOINTMENT:
Your payment confirmation
$20 Western Suffolk BOCES receipt
Green card (if applicable)
The financial obligation for this requirement rests with you. Western Suffolk BOCES does not
reimburse summer school instructional staff for this expense.
WESTERN SUFFOLK BOCES Formatted
Instructional Application for Regional Summer School -- 2012 Formatted ...
RETURN TO: Regional Summer School, 31 Lee Ave., Wheatley Heights, NY 11798 Formatted ...
Please Note: Any application that is received with missing or incorrect information will not be processed . Formatted ...
Position Requested: Teacher Regents Review Substitute Formatted ...
Registrar Proctor Grader Librarian
Name ________________________________________________________________ SS # __________________________ Formatted ...
(Last) (First) (Middle) Formatted ...
Other Name(s) __________________________________________ E-Mail_____________________________________ Formatted ...
(Please provide any additional information regarding maiden name, change of name, use of an assumed name or nickname
which is necessary to enable a check of your work or school records.) Formatted ...
(Street) (City) (State) (Zip) Formatted ...
Home Phone (____)_____________ Business Phone (____)______________ Cell Phone (____)______________________
Are you a N.Y.S. Retirement System Member? Yes No If yes, ERS or TRS Formatted ...
Please complete and sign the attached questionnaire, even if not a member, or you are a RETIRED MEMBER of either system. Formatted ...
Note, and of Enrollment___________________________
Membership Number___________________ Tier_____ Month, Day and Year of Enrollment Formatted ...
I do or I do not contribute into the Retirement System. Formatted ...
Are you a U.S. citizen? Yes No If no, are you legally eligible to work? Yes No Formatted
You will be required to provide identification and original proof of authorization to work in the U.S. ...
Have you ever worked for Western Suffolk BOCES? Yes No Year___________________________________ Formatted ...
Have you been fingerprinted? Yes No If yes, where? __________________________________________ Formatted ...
Teaching Experience: Complete ALL sections AND attach your résumé
Subjects Taught School District Years ...
Current Certification(s): A copy of all certificates MUST accompany completed application Formatted ...
Subject Areas Date of Issue State Formatted ...
I hereby authorize Western Suffolk BOCES to contact persons who may be familiar with my work or character. I waive my right of access to
any information provided by any references in the process of investigating my personal background and work record. Formatted ...
(Signature) (Date) Formatted ...
I certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I further acknowledge
that any falsification or omission will be sufficient cause for disqualification or dismissal if employed, regardless of what or when discovered.
The Board of Cooperative Educational Services of Western Suffolk County, New York does not discriminate on the basis of age, religion, creed, ethnic origin, marital status, race, color, sexual orientation,
veteran status, disability or handicap. This policy of non-discrimination includes the recruitment, hiring and advancement of employees; salaries, pay and other benefits. The Deputy Superintendent is Formatted ...
the coordinator of activities relating to compliance with Title IX and Section 504 of the Rehabilitation Act of 1973 (as ame nded) and may be contacted at: 507 Deer Park Road, PO Box 8007, Huntington
Station, New York 11746-9007.
Formatted: Font: 8 pt, Not Bold
NEW YORK STATE RETIREMENT SYSTEM QUESTIONNAIRE
I hereby acknowledge that I have been informed by Western Suffolk BOCES that as a Regional
Summer School employee not currently a member of the New York State Retirement System I
may, as a matter of right, join the New York State Retirement System.
I further acknowledge that I understand under present law if I choose to join the New York State
Retirement System, I must complete an application, which must be filed with the Retirement
System in order to be effective.
If I join the Retirement System, the employee contribution for the Teachers’ Retirement System
will be 3.5%, and the contribution for the Employees’ Retirement System will be 3% of my
salary. Any benefits that may be available would be available on a pro-rated basis.
I understand I am eligible for coverage either under the New York State Employees’
Retirement or the New York State Teachers’ Retirement System. I also understand if I do
not elect to join, I may be unable to obtain credit at a later date for service rendered during
the period I was not a member.
Please mark and sign one option.
I am currently a member of the Teachers’ Employees’
I am retired from the Teachers’ Employees’ Retirement
System as of (date of retirement).
Retirement Number Date of Membership
I decline membership in the Teachers’ Employees’ Retirement
I wish to join the retirement system. Please send me an application to enroll.
Formatted: No bullets or numbering