Suffolk Public Schools
P.O. Box 1549
Suffolk, VA 23439
APPLICATION FOR 2015ELEMENTARY SUMMER SCHOOL
LEARNING AND ENRICHMENT FOR ACADEMIC PROGRESS (L.E.A.P)
June 22 – July 28, 2016 – Academic Program 8:30 a.m. – 2:00 p.m.
**Pending Board Approval**
Please check one:□Teacher□Title I or Reading Endorsed Teacher□Media Specialist □Paraprofessional
□Program Coordinator-Academics □Nurse (8:30 a.m. – 3:30 p.m.)
□Office Assistant-paraprofessional (8:00 a.m. – 4:00 p.m.)
NAME______ID#______
ADDRESS______
Number & Street City StateZip
TELEPHONE______
CERTIFICATE:
*Do you have a Virginia Teacher’s Certificate? ______Yes ______No
If yes, what grades and/or subject area(s) are you endorsed to teach? (list)
______
*Do you have a Teacher’s Certificate from a state other than Virginia? ______Yes ______No
EXPERIENCE:
Current Teaching Position:
______
SCHOOL ASSIGNMENT SUBJECT(S)GRADE LEVEL LENGTH OF SERVICE
Previous Teaching Position:
______
School Assignment SUBJECT(S)GRADE LEVELLENGTH OF SERVICE
OTHER SCHOOL DIVISIONS:
______
PRESENT SCHOOL SUBJECT(S)GRADE LEVEL LENGTH OF SERVICE
Have you previously been employed as a summer school teacher with Suffolk Public Schools?
______YES ______NO If yes, ______elementary ______middle ______high
* Please attach the following summary: Teachers: Share how you would provide engaging thematic instruction while ensuring alignment of the curriculum. Program coordinator –Share how you will coordinate and provide ongoing support to the summer program. Office Assistant and Paraprofessional – Share skills and experience.
Have you ever been convicted of any offense involving the sexual molestation, physical, or sexual abuse or rape of a child? □yes □no
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal or professional history.
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Applicant’s Signature Date
Applications from present employees are to be submitted through the principal. Applications from persons not currently employed by our school division must be submitted to: Human Resources Dept. P.O. Box 1549 Suffolk, VA 23439-1549
APPLICATIONS MUST BE COMPLETED AND RETURNED TO PAMELA CONNOR BY January 28, 2016.
FROM PRINCIPAL: (This section ONLY for employees currently under contract to Suffolk Public Schools)
RECOMMENDATION
□I Do Recommend□I Do Not Recommend
SpecificComments:______
______
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Principal’s Signature Date
Suffolk City Public Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies.
Douglas Dohey, Chief of Operations
100 N. Main Street
P.O. Box 1549
Suffolk, VA 23439-1549
Phone: (757) 925-6750
Fax: (757) 925-6751
Email:
See website for program description.