APPLICATION FOR POSTED JOB VACANCY

MID-OHIO VALLEY TECHNICAL INSTITUTE

2134 NORTH PLEASANTS HIGHWAY

ST. MARYS, WEST VIRGINIA 26170

Telephone: 304-684-2464

FAX: 304-684-2544

PERSONAL DATA

Name: Date:

Phone #: Email:

Cell Phone #:

Home Address:

Are you a citizen of the United States? yes no

If not a citizen, please describe alien status:

POSTING INFORMATION

Position Applying for:

Closing Date of Posting:

Do you hold a valid teaching certification? yes no

If yes, issued in what state:

If yes, list yourWVEIS certification endorsement code number:

EDUCATION:

School Name &
Location / Degree or
Certification / Year of Completion & GPA
High School
Associate’s
Specialized
Training
Specialized
Training
Bachelor’s
Graduate
Other

WORK & EMPLOYMENT HISTORY: List below all past employment (including military service); beginning with the most recent. Use separate pages if needed.

  1. Current or most current:

Name of
Employer
Address
Type of
Business
Dates of
Employment
Your Name
(If different)
Salary
Telephone #
Name of
Supervisor
Describe the type of work you did
Reason for
Leaving

II.

Name of
Employer
Address
Type of
Business
Dates of
Employment
Salary
Telephone #
Name of
Supervisor
Describe the type of work you did
Reason for
Leaving

III.

Name of
Employer
Address
Type of
Business
Dates of
Employment
Your Name
(If different)
Salary
Telephone #
Name of
Supervisor
Describe the type of work you did
Reason for
Leaving

IV.

Name of
Employer
Address
Type of
Business
Dates of
Employment
Your Name
(If different)
Salary
Telephone #
Name of
Supervisor
Describe the type of work you did
Reason for
Leaving

V.

Name of
Employer
Address
Type of
Business
Dates of
Employment
Your Name
(If different)
Salary
Telephone #
Name of
Supervisor
Describe the type of work you did
Reason for
Leaving

VI.

Name of
Employer
Address
Type of
Business
Dates of
Employment
Your Name
(If different)
Salary
Telephone #
Name of
Supervisor
Describe the type of work you did
Reason for
Leaving

VII.

Name of
Employer
Address
Type of
Business
Dates of
Employment
Your Name
(If different)
Salary
Telephone #
Name of
Supervisor
Describe the type of work you did
Reason for
Leaving

PROFESSIONAL & CHARACTER REFERENCES (OTHER THAN RELATIVES):

List a minimum of three

Name / Address & Phone Number / Relationship

Summarize: Summarize any additional experiences, skills, specialized training, certificates, and credentials you feel are directly related to this employment opportunity.You may, if you wish, list any civic, business, or professional organizations of which you are a member. (Exclude reference to organizations denoting national origin, race, color, or religion.) Also use this space to explain any gaps in your employment history.

Teaching: Reason why you are interested in a teaching position at the MOVTI. Include in your response your personal educational philosophy.

ADDITIONAL INFORMATION: List any additional information that you feel would be helpful to your application.

Have you received a copy of the posted job description? yes no

Do you meet the qualifications & requirements as set forth in the job posting?

yes no

I affirm that my statements and answers on this application are correct to the best of my knowledge. I further authorize investigation of all statements contained in this application, and consent for listed references and representatives of current and past employers to freely discuss my character, professionalism, and work (i.e. ethic, quality, habits, and history) with MOVTI personnel.

Printed Name:

Signature:

Date of Signature: Social Security #:

Additional Information:

As required by Federal laws and regulations, the Mid-Ohio Valley Technical Institute does not discriminate on the basis of sex, race, color, religion, disability, age, and national origin in employment and in the administration of any of its education programs and activities.

Please be prepared to present copies of transcripts, certificates, and credentials; as well as college or employment portfolios at the date and time of your prospective interview.

According to state law, all persons employed for the first time by a public local education agency shall have a chest x-ray or approved tuberculosis test and the results must be on file at the office of the MOVTI’s fiscal agent.

West Virginia Law requires that public local education agencies request the record of any and all criminal convictions relating to child abuse, sex-related offenses or possession of controlled substances with intent to deliver same, from the West Virginia Criminal Identification Bureau for all future employees. Henceforth, all employment by the Council will be made pending verification by the Criminal Identification Bureau that the prospective employee has no criminal conviction in regard to the above stated areas.