Step 1 of 5

Position(s) Desired

Name(Required)

First Last

Social Security Number(Required)

Federal Privacy Act [5 U.S.C.§552A NOTE] Statement. Authority for requesting social security account numbers: Public School Code of 1949 [24 P.S. § 12-1212, 24 P.S. §1224] Principal Purpose: To verify certification. Other Purposes: GFSD (3/12/08)

Phone(Required)

Email(Required)

CurrentAddress(Required)

Street Address City State ZIP Code

Permanent Address (If Different From Above)

Street Address City State ZIP Code

List, In Order of Preference, The Grades, Subjects And/Or Positions For Which You Are Applying:

Certifications

(LIST ALL AREAS IN WHICH YOU HOLD VALID ARIZONA AND/OR OUT-OF-STATE TEACHING CERTIFICATES. NOTE: APPLICANTS HOLDING A CERTIFICATE FROM ANOTHER STATE MUST OBTAIN AN ARIZONA CERTIFICATE IN ORDER TO TEACH IN ARIZONA PUBLIC SCHOOLS.)

Area of Certification

Issuing State

Date Issued

Have You Acquired Tenure in Arizona?

In What School District

Date Available for Employment

If You Are Not Employed Full Time, Are You Interested In Being Placed On Our Substitute List?

Long Term

Short Term

Educational Background

High School

School/Institution and Location

Major/Minor

Diplomas, Degrees, or Credits Earned

GPA

College/University

School/Institution and Location

Major/Minor

Diplomas, Degrees, or Credits Earned

GPA

Grad School

School/Institution and Location

Major/Minor

Diplomas, Degrees, or Credits Earned

GPA

Experience

Present or Most Recent

Name of Employer

Address

Street Address City State ZIP Code

Phone Number

Start Date

End Date

Title

Worked Performed

Reason For Leaving

Name of Supervisor

Final Yearly Salary

2nd Most Recent

Name of Employer

Address

Street Address City State ZIP Code

Phone Number

Start Date

End Date

Title

Worked Performed

Reason For Leaving

Name of Supervisor

Final Yearly Salary

3rd Most Recent

Name of Employer

Address

Street Address City State ZIP Code

Phone Number

Start Date

End Date

Title

Worked Performed

Reason For Leaving

Name of Supervisor

Final Yearly Salary

Please list activities you are qualified to supervise or coach.

Identification and collection of criminal/disciplinary records for certified educators. Disclosure: Mandatory. Failure to provide the Social Security Number will result in an applicant not being considered for employment.

If you have not been previously employed in a teaching position, please complete the following:

1st School

Grade or Subject Taught

Name of School

Address

Street Address City State ZIP Code

College Supervisor

Cooperating Teacher

2nd School

Grade or Subject Taught

Name of School

Address

Street Address City State ZIP Code

College Supervisor

Cooperating Teacher

Student Teaching References:

Please attach photocopies of letters of reference and/or evaluations from college/university student teacher supervisor and cooperating teacher(s).

Max. file size: 128 MB.

REFERENCES

References should include superintendents, principals or professors who have first-hand knowledge of your professional competence and your personal qualifications. Experienced teachers should include the superintendent and principal of the two most recent schools in which employed. If any person(s) listed should not be contacted for reference at the present time, indicate in the left-hand margin the date contact(s) may be made.

List References

Name

Position

Address

Phone Number

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experiences (including U.S. military service) and/or state any additional information you feel may be helpful in considering your application, i.e. honors, awards, activities, technology skills or professional development activities:

ACT 34 (COMPLIANCE (Background Check of Prospective Employees)

Each applicant must submit with the employment application a State and Federal criminal history report or acopy of the completed form/request.

Max. file size: 128 MB.

ACT 151 (AZ Child Abuse History Clearance)

Each candidate must submit with his/her employment application a copy of an official clearance card obtained from the Arizona Department of Public Safety or a copy of the application applying to the Arizona Department of Public Safety for a clearance card. The clearance card must not be expired and valid. The applicant MUST submit the ORIGINAL report prior to employment.

Max. file size: 128 MB.

ESSAY

Please write an essay as described on page six. For your convenience, you may attach a sheet; however, your essay may not exceed one page. At the bottom of the attachment, please print and sign your name.

Max. file size: 128 MB.

CERTIFICATION AND RELEASE AUTHORIZATION

I certify that all of the statements made by me are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I further certify that I am the sole author of the essay. I understand that any misrepresentation of information shall be sufficient cause for: (1) rejecting my candidacy, (2) withdrawing of any offer of employment, or (3) terminating my employment.

I hereby authorize any and all of my previous employers and/or supervisors to release any and all of my personnel records, and to respond fully and completely to questions that officials of the Griffin Foundation School District may ask regarding my prior work history and performance. I will hold such previous employers and/or supervisors harmless of any and all claims that I might otherwise have against them with regard to statements made to this school district. I further authorize these officials to investigate my background, now or in the future, to verify the information provided and release from liability all persons and/or entities supplying information regarding my background. However, I do not authorize the production of medical records or other information, which would tend to actually identify a disability nor do I authorize inquiries which would include information related to any medical condition or medical history. Further, I do not waive any rights which I may have under state or federal law related to my right to challenge the disclosure of unlawful or inaccurate information, whether by the school district or by entities or persons providing such information to the school district, including any and all claims concerning allegations of employment discrimination because of race, color, sex, religion, national origin, ancestry, age or disability.

Date

Signature

_{Arizona school districts shall not discriminate in their educational programs, activities or employment practices based on race, color, national origin, sex, disability, age, religion, ancestry or any other legally protected classification. This policy is in accordance with state and federal laws, including Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, the Americans with Disabilities Act of 1990 and the Arizona Human Relations Act. Information relative to special accommodation, grievance procedure, and the designated responsible official for compliance with Title VI, Title IX, and Section 504 may be obtained
by contacting the school district.}

Certifications

Educational Background

Experience

Present or Most Recent

2nd Most Recent

3rd Most Recent

If you have not been previously employed in a teaching position, please complete the following:

1st School

2nd School

Student Teaching References:

REFERENCES

GENERAL BACKGROUND INFORMATION

CERTIFICATION AND RELEASE AUTHORIZATION