CAMPBELLSVILLE INDEPENDENT SCHOOL DISTRICT

136 South Columbia Avenue

Campbellsville, KY 42718

Phone: 270-465-4162

Fax: 270-465-3918

APPLICATION FOR CERTIFIED POSITION

To the applicant:

We appreciate your interest in our school system and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in considering you for a position that best meets your qualifications.

To be eligible for appointment to a teaching position in the Campbellsville Independent Public School System, it will be necessary for you to comply with the following procedures.

1. Fill out this application completely. You may provide additional information by letter or resume that will give a more complete account of your training, experience, and teaching ability.

2. Please provide a copy of your Kentucky Teaching Certificate with this application.

3. Please send an official transcript of your college credits with this application. If you must request a copy, you may file your application, and forward a transcript as soon as possible.

Candidates will be contacted for interviewing only when a vacancy occurs and after an initial screening of applications related to job requirements for that particular position.

THIS APPLICATION WILL REMAIN ACTIVE FOR THE CURRENT YEAR ONLY. (AN ACTIVE FILE OF CANDIDATES IS STARTED ON JULY 1 OF EACH YEAR.) SHOULD YOU DESIRE YOUR APPLICATION TO REMAIN ACTIVE FOR THE NEXT SCHOOL YEAR YOU MUST NOTIFY US, GIVING YOUR NAME, TEACHING AREA, CURRENT ADDRESS, AND TELEPHONE NUMBER.

PERSONAL DATA

Legal Name in Full ______Date ______

Present Address ______

Street Address City, State, Zip Telephone & Area Code

If you cannot be reached at the above telephone number during the day (8:00 – 4:00), please list a number where you may be reached:

______

CERTIFICATION IF KENTUCKY CERTIFICATION IS IN PROCESS CHECK HERE:______

______

Standard or Certified to Teach List Any Issued by Year Issued

Provisional or Grade Level or Area Endorsements What State

Internship Eligibility

______

POSITION DESIRED ______

______

Indicate Choice Elementary K – 4 Middle School 5 – 8 High School 9 – 12 Preschool

First Choice ______

Second______

Are you interested in Substitute Teaching or Instructional Assistant: ? Yes ____ No _____ Both ______

If there are any extracurricular/coaching positions for which you wish to be considered, list position and sport:

______

______

“FOR THIS TYPE OF EMPLOYEMENT, STATE LAW REQUIRES A NATIONAL AND STATE CRIMINAL HISTORY BACKGROUND CHECK AS A CONDITION OF EMPLOYMENT”.

“AN EQUAL OPPORTUNITY EMPLOYER”

“The Campbellsville Independent School Board of Education does not discriminate on the basis of race, color, national origin, age, religion, sex, or disability in employment, educational programs or activities.”

Date of Birth ______Social Security No.______

(Optional) Race: ___ Caucasian ___ Black ___ Other

RECORD OF EDUCATION

SCHOOL / NAME & ADDRESS OF SCHOOL / DATES
ATTENDED / MAJOR / MINOR / DEGREE & DATE RECEIVED
HIGH SCHOOL / ______
______
UNDER GRADUATE / ______
______
UNDER GRADUATE / ______
______
GRADUATE / ______
______

Give name in which Original Transcript was issued, if different from present name: ______

______

SUPERVISED TEACHING AND/OR INTERNSHIP ELIGIBILITY (Complete if you have less than five years of teaching experience.)

Subjects or Grades Taught:______

Training School: ______City, State: ______

SupervisingTeacher:______

Number of Semester Hours: ______Grade Received in Course: ______

College Supervisor: ______

PROFESSIONAL IMPROVEMENT INSERVICE

List such activities as travel, workshops, and summer sessions, speeches given before educational meetings, magazine articles published, etc.

YEAR / ACTIVITY
EMPLOYMENT

TEACHING EXPERIENCE (List in order of most recent experience.)

NAME
OF SCHOOL / CITY, STATE / GRADE OR SUBJECT TAUGHT / FROM / TO / NAME OF PRINCIPAL

SUMMARY OF TEACHING EXPERIENCE:

Kindergarten _____ years Middle/Junior High _____ years Administrative _____ years

Elementary _____ years Senior High _____ years Other _____ years

What type of contract do you have with your present employer? _____Limited _____Tenure _____Not Under Contract

Why do you wish to leave your present position? ______

______

______

______

WORK EXPERIENCES OTHER THAN TEACHING (List in order of most recent experience) Business, trades, summer occupations, scouting, social & religious services, recreation, etc.

Type of Work

/ Employer:
Firm or Institution / Address / From / To

The Campbellsville Independent Board of Education operates in compliance with the law concerning

NON-DISCRIMINATION ON THE BASIS OF HANDICAP ACT (P.L. 93-112).

GENERAL QUALIFICATIONS

Please answer the following question: What competencies and/or experiences do you have that would make you an excellent candidate for employment in Campbellsville?

______

REFERENCE CHECK

Give names of persons who have closely observed your works as a teacher, employee, or student. Please list all principals who have supervised your work. List supervising teacher(s) if you are a recent graduate. Please provide complete mailing address where mail can be received; especially in the summer months, when schools are not in session, and mail may not be forwarded for extended periods of time.

NAME / OFFICIAL POSITION
AND PHONE NUMBER / MAILING ADDRESS / CITY, STATE, ZIP

Comments: ______

Campbellsville Independent School District

136 S. Columbia Avenue

Campbellsville, KY 42718

Phone: 270-465-4162

Fax: 270-465-3918

To the Applicant: Date: ______

All applicants for teaching positions in the Campbellsville Independent School District must complete this supplement, which will be used in the screening process.

Last Name ______First Name ______Middle ______

Business Address______Phone ( )______

City ______Zip Code ______

Home Address ______Phone ( ) ______

Social Security Number ______Certification Area(s) ______

DIRECTIONS: Please answer each of the questions given below as best as you can. The space provided should be adequate, but if more space is needed, please attach additional pages.

1. What do you want to accomplish as a teacher? ______

______

2. How will (do) you go about finding out about students’ attitudes and feelings about your class? ______

______

3. An experienced teacher offers you the following advice: “When you are teaching be sure to command the respect of your students immediately and all will go well.” How do you feel about this? ______
______

4. How would you determine the curriculum for your class? ______

______

5. A parent comes to you and complains what you are teaching his child is irrelevant to the child’s needs. How would you respond? ______

6. What do you think will (does) provide you the greatest pleasure in teaching? ______

______

7. When you have some free time, what do you enjoy doing the most? ______

______

8. How do you go about identifying strengths and weaknesses of an average student? ______

______

9. Would you rather try a lot of way-out teaching strategies or would you rather try to perfect the approaches, which work best for you? Explain your position. ______

______

10. Do you like to teach with an overall plan in mind for the year, or would you rather just teach some interesting things and let the process determine the results? Explain your position. ______

______

11. A student is doing poorly in your class. You talk to her, and she tells you that she considers you to be the poorest teacher she has ever met. What would you do? ______

______

12. If there were absolutely no restrictions placed upon you, what would you most want to do in life? ______

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