MAGDALENA MUNICIPAL SCHOOLS
P.O. BOX 629
MAGDALENA, NEW MEXICO 87825
PHONE 854-2241 FAX 854-2531
Dear Applicant,
We welcome your request for an application of employment for the position advertised by the Magdalena Municipal Schools. We believe that we have one of the finest small school systems in New Mexico. The district is located in the beautiful mountains of the central-western part of the state. Our objective is to attract, employ and retain the most competent and highly qualified individuals possible for our students.
Thoroughly complete and return the attached application. All forms must be addressed in detail in order to conduct the required background investigation. References and prior work experience must contain complete names, dates and addresses in order to process the application properly. All parts of the application must be fully and accurately completed. Incomplete applications will not be considered.
Your application will be kept on file for a maximum of one year and then will be deleted from our files.
If you have questions concerning the position for which you are applying, please call for clarifications.
Sincerely,
Keri James
Human Resources
LICENSURE CODES
LICENSE / CERTIFICATE TYPES
100 K-12 ADMINISTRATIVE
104 K-12 LIFETIME ADMINISTRATIVE
150 K-12 INSTRUCTIONAL LEADER LICENSE
200 K-8 ELEMENTARY
208 K-8 LIFETIME ELEMENTARY
250 B-3 EARLY CHILDHOOD
300 7-12 SECONDARY
308 7-12 LIFETIME SECONDARY
350 5-9 MIDDLE LEVEL
400 K-12 SPECIAL EDUCATION
408 K-12 LIFETIME SPECIAL EDUCATION
410 K-12 BLIND AND VISUALLY IMPAIRED
500 K-12 SPECIALTY AREA
501 7-12 ATHLETIC COACH
502 K-12 EDUCATIONAL ASSISTANT
503 K-12 SUBSTITUTE TEACHER
505 K-12 LIFETIME SPECIALTY AREA
510 SCHOOL BUSINESS OFFICIAL
520 K-12 NATIVE LANGUAGE AND CULTURE
600 K-12 SCHOOL COUNSELOR
601 K-12 SCHOOL SOCIAL WORKER
605 K-12 REHABILITATION COUNSELOR
609 K-12 LIFETIME SCHOOL COUNSELOR
701 ASSOCIATE SCHOOL NURSE
702 PROFESSIONAL SCHOOL NURSE (RN)
703 SUPERVISORY SCHOOL NURSE (RN)
704 SCHOOL HEALTH ASSISTANT
705 SCHOOL LICENSED PRACTICAL NURSE (LPN)
800 7-12 SECONDARY VOCATIONAL TECHNICAL
900 K-12 EDUCATIONAL DIAGNOSTICIAN
901 K-12 SPEECH LANGUAGE PATHOLOGIST
902 K-12 AUDIOLOGISTS
903 K-12 OCCUPATIONAL THERAPIST
904 K-12 OCCUPATIONAL THERAPIST ASSISTANT
905 K-12 PHYSICAL THERAPIST
906 K-12 SCHOOL PSYCHOLOGIST
907 K-12 RECREATIONAL THERAPIST
908 K-12 MOBILITY TRAINER FOR THE BLIND
909 K-12 INTERPRETER FOR THE DEAF
910 K-12 PHYSICAL THERAPY ASSISTANT
911 K-12 EDUCATION INTERPRETER FOR THE DEAF
104 PROF ADMIN LIFE
208 PROF ELEM K-8
308 PROF SEC LIFE
408 PROF SPED LIFE
505 PROF K-12 LIFE
609 PROF COUNSELOR LIFE
ENDORSEMENTS
01 VISUAL ARTS
02 FINE ARTS
03 TECHNOLOGY EDUCATION
04 HEALTH
05 PHYSICAL EDUCATION
07 LIBRARY / MEDIA
08 PSYCHOLOGY
10 SOCIAL STUDIES
20 LANGUAGE ARTS
24 READING
27 TESOL
32 SCIENCE
45 INFORMATION TECHNOLOGY
47 BUSINESS EDUCATION
51 MATHEMATICS
60 MODERN AND CLASSICAL LANGUAGES
67 BILINGUAL EDUCATION
72 FAMILY AND CONSUMER SCIENCE
82 AGRICULTURE
90 MUSIC
LEVELS
** ONE-YEAR CERTIFICATE OF WAIVER
1LEVEL ONE PROVISIONAL (Use on 200, 250, 300, 350, 400, 500, 800 only)
1 LEVEL ONE (Use on all other “1” licenses)
1@ ONE-YEAR TEMPORARY CERTIFICATE (Coaches training & testing)
1A THREE-YEAR ALTERNATIVE
1B ONE-YEAR TEMPORARY CERTIFICATE (School Business Official training)
1C ONE-YEAR TEMPORARY CERTIFICATE (Teacher testing – needs Core NMTA)
1CS ONE-YEAR TEMPORARY CERTIFICATE (Teacher testing – needs Core and at
least one specialty area of NMTA)
1S ONE-YEAR TEMPORARY CERTIFICATE (Teacher testing – needs at least one
specialty area of NMTA)
1E FOR FOREIGN TEACHERS WHO HAVE NOT PASSED LICENSURE TESTS OR WHO DO NOT HAVE 24
SEMEMSTER HOURS IN CORE CONTENT AREAS. Must pass test(s), complete 24 semester hours, or
complete HOUSSE process locally before obtaining Level II licensure
1I
2I INTERNS in alternative licensure route for first, second, and third years
3I
1L LICENSE LIMITED TO ONE SCHOOL DISTRICT (includes district code)
1P TEMPORARY CERTIFICATE (Professional Development Plan)
2 LEVEL TWO PROFESSIONAL On 200, 250, 300, 350, 400, 500, and 800 only)
2 LEVEL TWO (Use on all other “2” licenses)
3 LEVEL THREE
3A LEVEL THREE-A Instructional Leader
3B LEVEL THREE-B Administrator
MAGDALENA MUNICIPAL SCHOOLS
P.O. BOX 629
MAGDALENA, NEW MEXICO 87825
PHONE 854-2241 FAX 854-2531
APPLICATION FORM (LICENSED PERSONNEL)
You must fully and accurately complete this Application for Employment.
Incomplete applications will not be considered.
This Application for Employment will be inactive after ninety (90) days.
If you want to be considered after that time, you must complete a new
Application for Employment
Date of Application: /PERSONAL INFORMATION
/ Social Security #:Last Name / First Name / Middle Name
Present Street Address / City / State / Zip Code / Telephone #
Address to which you wish communication sent / City / State / Zip Code / Telephone #
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? Yes No
List any other names under which information may be received:
POSITION DESIRED:TeacherCounselor Nurse Librarian Administration Other
SUBJECT CHOICE:
Senior High School (Subject) Middle School (Subject)
1.1.
2.2.
______Elementary School (Grade Level)Special Education (Area Level)
1. 1.
2. 2.
Other
LICENSURE INFORMATION
Do you possess a valid New Mexico Teaching license?YesNo
If yes, Type: License No. Exp. Date:
Endorsements:
If no, have you applied for licensure in New Mexico? YesNoDate of Application:
Have you ever had a teaching license revoked or suspended in any state? Yes No
If yes, please explain:
IMPORTANT: It is the candidate’s responsibility to acquire licensure/certification for which he/she is applying. Inquires regarding New Mexico licensure should be directed to: Division of Teacher Preparation and Licensure, State Department of Education, Education Building, Santa Fe, New Mexico 87501-2786
Have you passed the NTE (Nation Teachers’ Exam)? Yes No
If yes, Date: Place:
Score:
General Knowledge: Professional Knowledge Communication Skills
Percentile Rank Percentile Rank Percentile Rank
EDUCATION
Name of School-Location
(include high school, college, graduate work)Degree GPA Major Minor
GENERAL
What college or university distinctions have been awarded to you?
List briefly any published or unpublished research you have done:
Are there any problems or reasons other than a disability, which may prevent you from accepting any school assignment for which you are qualified? Yes No Explain:
Of what professional organizations are you a member?
When will you be available?
Are you currently under contract with any employer? Yes No
Expiration Date of Contract
Have you filed an application with us before? Yes NoWhen?
Under what name?
SCHOOL ACTIVITIESCheck the following activities you are able to coach, direct, or sponsor,
Where requested, circle “B” for boys and/or “G” for girls
Baseball B Golf B GSwimmingB GTennis B G
Basketball B G Soccer B GTrackB GVolleyball B G
Cross Country B G Football B SoftballSpeech
Cheerleaders Wrestling BDebateScience Fair
Dramatics Student Council YearbookOther
Drill Team Academic Clubs Newspaper
If “Other” checked, please list/explain:
Please list and explain any special characteristics, skills, and/or experiences that you believe would be assets
EXPERIENCE IN THE FIELD OF EDUCATION
Fields, subjects
Name and Address of School Dates of grades taught SupervisorPhone
STUDENT TEACHING:
School:Location:
Subjects taught:Date: Grade earned:
Reasons for leaving present or most recent position:
NON-EDUCATION RELATED EXPERIENCE
Company/Firm / Address / Type of Work / From Mo/Yr / To Mo/Yr / SupervisorREFERENCES
If you have had teaching experience, include all of your immediate supervisors among your references. If you have had no teaching experience, include references familiar with your work in methods courses and student teaching.
Name / Position / Address / PhonePLEASE READ CAREFULLY
Have you ever been convicted of, or placed on probation for, the commission of any felony or a misdemeanor involving moral turpitude? Yes No If yes, describe full details on a separate sheet.
CREDENTIALS AND REFERENCES - If you credentials or confidential papers are on file in a college placement bureau, please have them forwarded to this Personnel Office.
ELEMENTARY AND SECONDARY TEACHING FIELDS
Please list semester hours of credit in all subjects which you have completed, or anticipated completing, prior to the date you will be available for employment. (When in doubt where to list a course, list it in your major field.) This information is necessary in making proper assignments.*
YOUR APPLICATION WILL NOT BE PROCESSED IF THIS PAGE IS INCOMPLETE.
RECORD CREDIT IN SEMESTER HOURS (3 quarter hours = w semester hours or quarter hours X 2/3 = semester hours.)
Under Under
GraduateGraduate GraduateGraduate
EDUCATION (Total Credits)
Administration
Curriculum Construction
Methods &Techniques
Reading Content Area
Student Teaching
Tests & Measurements
Other Education
ART (Total Credits)
Art Education
Ceramics
Drawing and Painting
Graphics
Jewelry
Sculpture &Construction
Weaving
Other Art
BUSINESS (Total Credits)
Accounting
Business Law
Data Processing
Distribution/Marketing
General Business/Economics
Office Machines
Shorthand
Typing
Vocational Office Education
Other Business
Other Business
Other Business
ENGLISH (Total Credits)
Composition
Drama
TESOL
Grammar
Journalism
Literature-American
Literature-English
Literature-World
Reading
Speech
Other Language Arts
OTHER LANGUAGES (Total Credits)
French
German
Latin
Russian
Spanish
Other
HOME ECONOMICS (Total Credits)
Clothing & Textiles
Early Childhood
Food & Nutrition
Home & Family
Vocational/Cooperative Ed.
Other Home Economics
INDUSTRIAL TECHNOLOGY (Total Credits)
Drafting-Architectural
Drafting-Mechanical
Electricity
Electronics
Graphic Arts
Industrial Plastics
Mechanics-Auto
Mechanics-Power
Metals Technology
Woods Technology
Other Industrial Arts
Trades/Industry/ICT
MATHEMATICS (Total Credits)
Algebra
Calculus
Computer Science
Geometry-College
History of Mathematics
Number Theory
Probability & Statistics
Theory of Equations
Trigonometry
Other Mathematics
MUSIC (Total Credits)
Band
Chorus
Fundamentals of Music
Major Instrument (List)
Minor Instrument (List)
Music History
Music Theory
Piano
Strings
Voice
Other Music
SCIENCES (Total Credits)
Agriculture
Astronomy
Biology
Chemistry
Earth Science
General Science
Physics
Health (listed on next page)
SOCIAL SCIENCES (Total Credits)
Anthropology
Economics
Geography
History-American
History-World
Political Science
Psychology
Sociology
Other Social Studies
SUBJECTS NOT LISTED (Total Credits)
ELEMENTARY AND SECONDARY TEACHING FIELDS (Continued)
Under
GraduateGraduate
ELEMENTARY (Total Credits)
METHODS COURSES
Arts & Crafts
Children’s Literature
Diagnostic/Prescriptive Reading
Early Childhood
Language Arts
Mathematic
Music
Safety
Science
Social Studies
Teaching of Reading
Other Elementary
Student Teaching
GUIDANCE/COUNSELING (Total Credits)
Counseling
Counseling-Handicapped
Counseling-Vocational
Growth, Development & Learning
Practicum in Guidance/Counseling
Other Guidance & Counseling
Area of Concentration:
Elementary_____
Check One: Secondary_____
K-12_____
BILINGUAL. (Total Credits)
Bilingual Pedagogy
NM &/or Southwestern History
Sociology of Ethnic Experience
Practicum in a Bilingual Program
Language Pedagogy
Cross-Cultural Psychology
Hispanic Civilizations
Spanish Peninsular Literature
Spanish-American Literature
SPECIAL EDUCATION (Total Credits
NUMBER IN ORDER OF PREFERENCE:
_____General Special Education
_____Communicatively Disordered
_____Hearing Impaired/Deaf
_____Visually Impaired/Blind
_____Gifted
_____Learning Disabled
_____Behavioral Disordered
_____Physically Impaired
_____Mentally Handicapped
_____Severely/Profoundly Handicapped
Under
GraduateGraduate
LIBRARY SCIENCE (Total Credits)
Audio-Visual
Cataloguing
Library Administration/Organization
Reference
Other Library Science
Area of Concentration:
Elementary _____
Check One: Secondary _____
K-12 _____
PHYSICAL EDUCATION (Total Credits)
Baseball
Basketball
Corrective Physical Education
Fold & Modern Dance
Football
Golf
Gymnastics
Recreation
Swimming
Tennis
Track
Wrestling
Other Physical Education
Area of Concentration:
Elementary _____
Check One: Secondary _____
K-12 _____
HEALTH (Total Credits)
Anatomy/Physiology
Consumer Health
Drug Education
Human Sexuality
Mental/Emotional
Personal/Community
Other Course(s)
OTHER AREAS OF SPECIALIZATION
(Total Credits)
Check and List Courses:
_____ Career Education
_____Corrective Therapy
_____Diagnostician
_____Military Science
_____Nursing
_____Occupational Therapy
_____Physical Therapy
_____Reading
_____Social Work
_____Speech Pathology
_____Driver’s Education
AGREEMENT/AUTHORIZATION, WAIVER, AND RELEASE
I, hereby, certify that the information contained in this application is true, accurate, and complete to the best of my knowledge and belief. I understand and agree that any misrepresentation or willful omission of facts shall be sufficient cause for disqualification of my application or for termination of employment. Failure to provide all or part of the information requested may result in the refusal of t he Magdalena Municipal Schools to further consider me for possible employment.
I, hereby, authorize the Magdalena Municipal School district and its agents to investigate my work history and education history, as well as conduct personal inquires. I understand the School District will send a copy of the Agreement, Authorization, Waiver, and Release to each individual or entity from which it is seeking a reference or background information.
I, hereby, authorize the party receiving a copy of this signed and notarized form (including a photocopy or facsimile copy) to provide and release complete information as may be requested, and I, hereby, waive any claim of confidentiality I might have with regard to such information.
I, hereby, release any person or entity providing information of records in accordance with the Agreement, Authorization, Waiver, and Release from any and all claims or liability for compliance.
I hereby authorize you to release information regarding my prior employment ______for the purpose of the Magdalena Municipal School’s employment investigation. You are released from any and all liability that may result from furnishing such information to the Magdalena Municipal School District. In addition, I hereby recognize and acknowledge your immunity from liability as set forth in New Mexico Statutes Annotated 50-12-1 (1995).
I understand and agree that if I am considered as a finalist for, or I am actually recommended for employment, I will submit to a criminal background investigation, including mandatory fingerprinting, at my expense, to determine my acceptability for employment. Criminal convictions shall not automatically bar an application for obtaining employment with the Magdalena School District, but, pursuant to the Criminal Offender Employment Act of New Mexico (NMSA 1978, Section 28-2-1 Et. Seq.) such convictions may be the basis for refusing employment, I understand that any employment offer is contingent upon the satisfactory completion of all background checks.
I understand that the information contained in the application and the information submitted by me or obtained pursuant to the Agreement, Authorization, Waiver, and Release is confidential, for the exclusive use of the Magdalena Municipal School District and its agents for employment decisions, and will not be transferred to any other entity without my written authorization unless required to be disclosed upon request by either New Mexico or federal law.
Social Security Number
Driver’s License Number and State
SIGNATURE OF APPLICANT DATE
(Attention Notary – Ensure document is signed in your presence.)
SUBSCRIBED AND SWORN TO ME THIS DAY OF
(SEAL)
NOTARY PUBLIC SIGNATURE
MY COMISSION EXPIRES
If employed, a cashier’s check or money order in the amount of $44.00 payable to 3M Cogent for a “New To the District Background Check,” will be required.