New Lenox School District 122

NEW LENOXSCHOOL DISTRICT 122

102 South Cedar Road

New Lenox, Illinois60451

815-485-2169

Fax 815-485-2236

APPLICATION FOR EMPLOYMENT

CERTIFIED PERSONNEL

Application Date______Date Available for Employment______

PERSONAL INFORMATION:

Name______

Last First Middle Init. Maiden

Present Address______

Street City State Zip

Telephone ( )______Alternate Telephone ( )______

Permanent Address______

Street City State Zip

Telephone ( )______Alternate Telephone ( )______

Social Security Number______Email ______

EMPLOYMENT PREFERENCE:

APPLICANTS ARE EMPLOYED TO TEACH IN THEIR FIELDS OF CERTIFICATION

1. Position Applied For: ______

2. Type of Application:

(A) Full Time ONLY ______(B) Temporary or Part Time ONLY ______(C) Either (A) or (B)

3. Kind of Employment:

(A) Elementary School Teacher (K-6) ______(B) Junior High School Teacher (7-8) ______

Special Education Teacher,etc.) ______Specify: ______

4. Elementary Applicants – Rank in order of grade-level preference:

K______1______2______3______4______5______6______

5. Junior High Applicants (Junior High Applicants MUST have 18 hours in their teaching field):

(a) Major Teaching Field: ______

List the subjects you are qualified to teach in your major:

1______2______3______4______5______

(b)Minor Teaching Field: ______

1______2______3______4______5______

(c)Other areas you are qualified to teach or supervise:

1______2______3______4______5______

CERTIFICATES HELD:

TYPENUMBER

______

EDUCATION:

NAME OF SCHOOL / LOCATION / DATES
ATTENDED / DATE OF
GRADUATION / DEGREE
EARNED
HIGH SCHOOL:
COLLEGE/UNIV:
COLLEGE/UNIV:
COLLEGE/UNIV:

Total Semester Hours Beyond Highest Earned Degree: ______

COLLEGE WORK:

In what field are you majoring? ______Elementary ______Secondary

COURSE STUDY / TOTAL SEMESTER
HOURS / GRADEPOINTAVG.
MAJOR:
MINOR:
MINOR:

Please List Total Hours of Education Courses: ______Approximate Overall Grade Point Average: ______

PRACTICE TEACHING:

1. School and Location ______

Cooperating Teacher______Subject or Grade Level Taught______

Telephone(Work)______(Home)______

2. School and Location ______

Cooperating Teacher______Subject or Grade Level Taught______

Telephone(Work)______(Home)______

PROFESSIONAL REFERENCES:

Name______Name______

Position______Position______

Street______Address______

City/St/Zip______City/St/Zip______

Telephone (Work)______Telephone (Work)______

Telephone (Home)______Telephone (Home)______

Name______Name______

Position______Position______

Street______Address______

City/St/Zip______City/St/Zip______

Telephone (Work)______Telephone (Work)______

Telephone (Home)______Telephone (Home)______

EMPLOYMENT REFERENCES:

List below a complete chronological history of professional experience, startingwith the most recent. Include supplemental sheets

if space is inadequate.

EDUCATION EXPERIENCE:

SCHOOL
YEAR / SCHOOL / CITY/STATE / GRADES/
SUBJECT / IMMEDIATE
SUPERVISOR / TELEPHONE

Are you currently under contract? YES_____ NO_____ If “YES”, may we call your supervisor? YES_____ NO_____

Name of School Districtwith whom you are currently under contract ______

Are you tenured under your present position? YES_____ NO_____

Have you ever been requested to resign from a position or not been reappointed? YES_____ NO_____ If “YES”, you may wish

to submit details on a separate piece of paper.

Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? YES_____ NO_____

WORK EXPERIENCE AND/OR MILITARY SERVICE OTHER THAN TEACHING:

DATE / EMPLOYER / CITY/STATE / JOB
TITLE / IMMEDIATE
SUPERVISOR / TELEPHONE

May we contact the employers listed above? YES_____ NO_____ If not, indicate by “NO” next to the one(s) you do not wish

us to contact.

List any friends or relatives working for NewLenoxSchool District 122:

______

Thank you for completing this application and for your interest in employment with NewLenoxSchool District 122. We would like to assure you that your opportunity for employment with District 122 will be based only on your qualifications, experience, and/or merit and on no other consideration.

PLEASE READ CAREFULLY

APPLICANT’S CERTIFICATION AND AGREEMENT

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I voluntarily give NewLenoxSchool District 122 the right to make a thorough investigation of my past employment, personal history, financial and credit record, and personal activities, and pledge to cooperate in such investigation. I hereby release from all liability responsibility all persons, companies, credit agencies, and corporations, supplying such information.

I consent to taking any required pre-employment examination and such future examinations as may be required by the District.

I agree that the entire contents of this application form, as well as the report of any such examination, may be used by the District in whatever manner it may wish.

I understand that if employed, falsified statements on this application or interview(s) shall be considered sufficient cause for immediate discharge.

If employed by NewLenoxSchool District 122, I understand that such employment is subject to the policies, rules, and regulations of the District and understand that I am required to abide by all such rules and regulations.

This application is active for 12 months following filing date. Applicant must reactivate

application to be considered after that date. You will be notified if a personal interview

is required. Please note that not all applicants are called for a personal interview.

______

Signature of ApplicantDate

I certify that to the best of my knowledge the facts set forth in my application are accurate and complete. In signing this document, I agree

toabide by all policies and procedures outlined in the New Lenox School District Board of Education Policy and Procedure Manuals.

Signature of Applicant______Date______

PLEASE RETURN COMPLETED APPLICATION TO:

Superintendent

New Lenox School District 122

102 South Cedar Road

New Lenox, Illinois 60451

Certified Application

Rev 5/5/2016