Teacher/Professional Job Application BEFORE YOU FILL OUT THIS APPLICATION BE SURE YOU READ AND UNDERSTAND THIS We ask certain questions concerning your health and your criminal history. We verify the answers you provide through appropriate agencies. As an educational agency, we are entitled to a complete criminal history report on you. This report includes anything for which you have been arrested and/or convicted. This report also includes information on arrests, convictions, or pleas bargains for which you may have subsequently received pre-trial interventions, pardons, or expungements. That does not excuse you from listing these on your application even if the charges were dropped. There is no time limit or other reason to fail to report an arrest or conviction. YOUR SIGNATURE BELOW INDICATES THE FOLLOWING: You have read and understand the above. You understand that your employment is contingent upon a satisfactory record check that is in accordance with the answers you provided. Record checks sometimes take significant time to be returned. You understand that our offer of employment is based on an evaluation of the information you provided. If that information is inaccurate, false, or misleading, that will be grounds to terminate your employment upon receipt of the report. Signature Date
Teacher/Professional Application For Employment MADISON PARISH SCHOOL BOARD 301 South Chestnut Street Tallulah, Louisiana 71282 Phone: 318.574.3616 Fax: 318.574.3667 OFFICE USE ONLY ID/SS CARD DIPLOMA CERTIFICATE TRANSCRIPT PRAXIS ALL APPLICANTS MUST PROVIDE THE FOLLOWING AT THE TIME THE A PPLICATION IS SUBMITTED: 1. Copy of current Driver s License OR Official Identification Card 2. Copy of Social Security Card AND Birth Certificate 3. Copy of college diploma OR transcripts indicating degree earned 4. Copy of teaching certificate if applying for a teaching or administrative/educational leader position 5. Copy of NTE, PRAXIS test scores OR ACT(22+) if applying for teaching or administrative/educational leader position ** Current employees do not need to include the documents listed above when applying for a different position ** CHECK THE POSITION FOR WHICH YOU ARE APPLYING POSITION JOB REQIREMENT Teacher Specify grade level and/or subject(s) preferred Educational Leader/Administrator- Specify position(s) Minimum of Bachelor s degree, valid teaching certificate or meet requirements for a temporary Louisiana teaching certificate (passing scores on Praxis Pre-Professional Skills Test) Valid Educational Leader or Administrator/Supervisor certificate of eligibility to apply for a Louisiana Educational Leader certificate Other professional position- Specify position(s) As listed on specific job description INDICATE IF APPLYING FOR A SPECIFIC ADVERTISED POSITION Date of Application Social Security Number Name Last First Middle/Maiden Address Street City State Zip Code Home Phone Mobile Phone _ United States citizen Yes No If not, do you have legal right to work in this country? Yes No Are there any reasons which would prevent or restrict you from discharging your duties or responsibilities according to the Madison Parish School Board job description?
CERTIFICATE AND/OR LICENSE - Include all teaching and ancillary certificates, special endorsements, NBPTS certificates, or any other local, state or national license. STATE TYPE & NUMBER ISSUE DATE EXPIRATION DATE AREAS OF CERTIFICATIONS OR ENDORSEMENT EDUCATION HISTORY- List all degrees earned NAME & LOCATION OF SCHOOL DEGREE DATE EARNED/EXPECTED MAJOR FIELD OF STUDY EMPLOYMENT HISTORY AND/OR TEACHING EXPERIENCE- List last four employees, beginning with most recent DATES OF EMPLOYMENT EMPLOYER or SCHOOL DISTRICT AND LOCATION (include complete address) JOB or TEACHING ASSIGNMENT REASON FOR LEAVING I understand that it is my responsibility to obtain forms for verification of previous employment from Human Resources Department and send them to past employers. I understand that I may not be given salary credit for past employment until the forms are received and approved by the Human Resources Department. Initial
MILITARY EXPERIENCE Dates of service Branch Final Rank Type of discharge Work Performed REFERENCES- Provide the names of at least four (4) persons who have knowledge of your professional skills and abilities FULL NAME OFFICIAL POSITION COMPLETE MAILING ADDRESS PHONE NUMBER BACKGROUND 1. Have you ever been arrested for any crime, whether a felony or misdemeanor? Yes No Note: Madison Parish School Board will have access to all arrest records even if not convicted 2. Have you ever been convicted of an offense against the law or are you now under charges Yes No for an offense against the law? 3. Have you ever been terminated or recommended for dismissal by your employer? Yes No 4. Have you ever had a professional license or certification revoked? Yes No 5. Are you related to an employee/board member of Madison Parish School Board? Yes No 6. Are you retired from the LA Teacher s Retirement or School Employee s Yes No Retirement System? 7. Did you participate in DROP (Deferred Retirement Option Program)? Yes No 8. Are you receiving Worker s Compensation? Yes No 9. Have you worked for the Madison Parish School Board before? Yes No 10. Are you currently under contract with another school system? Yes No If you checked Yes for any of the questions above, please explain in the space below:
When would you be available to accept employment in the Madison Parish School District? Are you interested in coaching or sponsoring a student activity? Yes No If yes, explain RELEASE INFORMATION Please initial each item below I authorize Madison Parish School Board to investigate my background, references, character, past employment, education, criminal or police records for the purpose of confirming the information in this application and/or obtaining information pertinent to my qualifications for employment. I authorize Madison Parish School Board to request information from my current or previous employer (city, parish, or other local public school board) relative to all instances of sexual misconduct with students committed by me. I hereby release Madison Parish School Board, employers, schools, or persons from liability in responding to inquiries in connection with my application. I understand that I must abide by the terms of the Madison Parish Drug-Free Workplace policy. As part of the application process, I understand that I must submit to a pre-employment drug screen. If employed, I understand that false or misleading information given in my application or Interview(s) may result in discharge. I CERTIFY THAT ANSWERS GIVEIN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I HAVE READ AND AGREE WITH THE INFORMATION PROVIDED TO ME. Signature Date Madison Parish School System is an equal opportunity employer. Applicants are considered for employment on the basis of qualifications without regard to race, color, national origin, religion, age, sex, or handicapping condition. As provided by Federal Law, applicants may request accommodations in order to complete the application or to take any required employment.
WRITING SAMPLE FOR TEACHERS/ADMINISTRATORS The Madison Parish School District seeks candidates for teaching or administrative positions who can express themselves in a clear, cogent and grammatically correct manner. Such competency is essential regardless of grade level or subject area. In completing this application, submit a handwritten statement expressing why you are applying to this district for a teaching or administrative position. Your statement should also indicate the specific contributions you can make to our district. Use the space below to complete your writing sample.
AUTHORIZATION AND RELEASE IMPORTANT: READ CAREFULLY Louisiana Revised Statutes 17:3884 provides that school board considering the employment application of a person who has been evaluated in another school system shall request such person's evaluation results as part of the application process and shall inform the applicant that his/her evaluation results will be requested. The applicant shall be given the opportunity to review any information received by the prospective employer as a result of such request and to provide any response or information the applicant deems appropriate. Please be advised, therefore, at the Madison Parish School Board will request your evaluation results from each of the school districts you have listed in your application. You will be given an opportunity to review the evaluation results received and to provide a response or information if you would like to do so. Any written response or information you might provide will be retained with your application. Louisiana Revised Statutes 17:15 also requires all applicants for employment to fingerprinted in order to assist in background checks of those individuals. Should it be dctcm1incd that any applicant (or employee) has been convicted of one or more of the criminal offenses set forth in Louisiana Revised Statutes 17:587.1 (C), then that applicant (or employee is generally precluded from further employment with the school system. Your conviction of other, non-listed offenses may also render you ineligible for employment or continued employment. Failing to disclose an arrest or conviction or providing any other incomplete or inaccurate information on your application shall also be grounds for termination. Expunged convictions will be reflected in the background check we receive. Louisiana Revised Status 17:81.9 further requires a school board receiving an application to request that all current and prior school board employers of the applicant provide it with all information in their records relative to instances of sexual misconduct with committed by the applicant. if any. Louisiana Revised Status 17:81.9 and 17:430 further required all applicants to make certain disclosures relative to prior abuse and neglect allegations, if any. The applicant must also release all such employers from liability arising from the release of such information to the prospective employer. While you may be interviewed and selected tor potential employment by the school principal, any offer of employment is not official or binding, unless approved by the superintendent in advance. Any offer of employment is also conditional and subject of being withdrawn pending our receipt and review of the results of your background fingerprint results, even if you have already been placed in a position. Should your background/fingerprint results render you ineligible for employment, you shall he compensated for all hours worked. above. My signature herein with indicates that I have read, acknowledge and agreed to the provision set forth APPLICANT DATE
ABUSE AND NEGLECT INQUIRY Pursuant to the foregoing statutes, you must answer each of the following questions truthfully and completely. If your answer to any question is Yes, you must complete the explanation question thereunder. Any applicant who knowingly and willfully provides incomplete or false answers to any of the following questions shall be guilty of a misdemeanor and shall not more than five hundred dollars or imprisoned for not more than six months, or both. You must answer each of the following: (Check "Yes" or "No") 1. Have you ever engaged in sexual misconduct with a minor student? Yes No 2. Have you ever been accused of sexual misconduct with a minor or student? Yes No 3. Within thirty-six months before or after your resignation, retirement, or Yes No termination from your previous employment, have you been the subject of any investigation of alleged sexual misconduct with a minor or student? 4. Have you ever abused or neglected a minor or student? Yes No 5. Have you ever been accused of abusing or neglecting a minor or student? Yes No 6. Have you ever been subject to an investigation of alleged neglect or abuse Yes No of a minor student?
For each question above to which you answered "Yes," please provide the following information as to each affirmative response (additional sheets are available): Question No: Nature of Allegation: Identity of Employer at the time: Approximate Date of Allegation: Identity of Person Making the Allegation: _ Identity of Person or Agency responsible for Investigation and contact information: Person(s) with most knowledge of investigation and contact information: Results of Investigation (termination of employment, arrest, plea, conviction, dismissal of charges, other): Question No: Nature of Allegation: Identity of Employer at the time: Approximate Date of Allegation: Identity of Person Making the Allegation: _ Identity of Person or Agency responsible for Investigation and contact information: Person(s) with most knowledge of investigation and contact information: Results of Investigation (termination of employment, arrest, plea, conviction, dismissal of charges, other):
CERTIFICATION, AUTHORIZATION AND RELEASE IMPORTANT: READ CAREFULLY I certify that the information which I have provided in the attached application package is true and complete. I understand that furnishing inaccurate or false information or omitting information on this application could disqualify me from consideration for employment, could lead to my discharge from employment, or could constitute a crime. I hereby authorize the Madison Parish School Board to request, receive, and review my prior evaluations and inform relative to sexual misconduct and/ or abuse (if any) with minors or students from all of my current or previous school system employers. I further release the Madison Parish School Board and all current and former employers, their agents and employees from any liability connected the such disclosures and do hereby specifically authorize such employer(s) to release to the Madison Parish School Board such information and documentation as may be requested in connection with my application for employment with it. Copies of this document may be accepted as originals. I also affirm that I have not been terminated from any prior school system employer nor have I resigned my employment with a school system in lieu of termination. STOP! CAREFULLY REVIEW YOUR ENTIRE APPLICATION BEFORE SIGNING. I have read and reviewed all of the information in this application prior to signing below. All information provided herein above and in the attached documents is true, accurate and complete. As the applicant, I acknowledge that any offer of employment must be approved by the Superintendent. Signature Date Printed Name: