Personal Information:
Last Name / First Name / M.I.
Street Address
City / State / Zip
Date:
Phone #:
Cell #:
Work #:
E-mail:
Position Applying for: / Full-Time / Substitute

Are you currently under contract to another district? Yes No

Name of School District
/ Your Title / Contract Expiration Date / District Enrollment (ADM)
Date Available for Employment / Current Base Salary (excluding fringe benefits) / Base Salary Expectations (excluding fringe benefits)
Educational History: (start with high school and list all colleges attended)
School Name / Location / Major Course of Study / Attended / Graduated / Degree
From / To / Yes / No

Certification/ Indicate below, the type and grade of the Ohio Certificate and/or License you hold.

Licensure: If you do not hold an Ohio Certificate and/or License, have you made application for one? ____

Are you certified in another state? ______Please indicate which state ______

Type & Grade

Of Certificate/License / Date
Issued / Expiration
Date / Certificate/License
Number / Grades or
Subjects Covered

Have you ever been convicted of a felony? ______If yes, please explain on a separate sheet of paper.

Note: Candidates are subject to a criminal background check.

Military Experience:

Branch of Service / Years / Date Enlisted / Discharge Date
Present Military Affiliation / Term of Enlistment

Professional Experience:

Starting with most recent, list all previous employers. If more space is required, please continue on a separate sheet.

Dates

/ Assignment
Grade / Subjects / School District / Address / Salary / Reason for Leaving

Fr

/

To

Other Work Experience and Achievements Valuable to Your Career:

.

Professional/Work References:

Please list below the names and addresses of three (3) persons who can speak of your professional competency and character.

Name / Type of Acquaintance / Years Known
Street Address, City, State, Zip / Home Phone / Business Phone
Name / Type of Acquaintance / Years Known
Street Address, City, State, Zip / Home Phone / Business Phone
Name / Type of Acquaintance / Years Known
Street Address, City, State, Zip / Home Phone / Business Phone

Does the Board or its agents have your permission to contact the above named persons? Yes No

Does the Board or its agents have your permission to contact your current employer? Yes No

Why Are You Interested In this Position?

Identify Two Major Accomplishments In Your Last Position:

Identify Two Projects That Didn’t Get Accomplished Despite Your Best Effort and Why:

When employed, an official transcript of all credits and certificate(s) must be on file in the office of the Bellefontaine City School District.

A Complete Application Consists of the Following:

1.  Receipt of a letter of application emphasizing qualifications and recent achievements.

2.  Receipt of a completed and signed application form.

3.  Receipt of an up-to-date resume.

4.  Receipt of a copy of current Administrative Certificate/License.

5.  Receipt of your university placement file and/or transcript of credits.

6.  Receipt of three letters of reference.

7.  You may submit any information or material you feel is relevant to your qualifications for this position.

Comments: You may attach additional information that may be helpful in making an employment decision.

Your application will remain on file for one year.

The Bellefontaine City School District does not discriminate on the basis of sex, religion, color, age, national origin, size handicapping condition, or race in educational programs and activities nor in its employment practices.