Odessa-Montour Central School District

(607) 594-3341

Employment Application for Teachers/Administrators

Personal Information

(First Name) (Middle Initial) (Last Name)

Physical Address City State Zip

Mailing Address (if different) City State Zip

Home Phone Cell Phone Social Security # E-mail Address

The Odessa-Montour Central School District is committed to a learning environment that actively supports all students, faculty and staff. The Odessa-Montour Central School District is an Equal Opportunity Employer and complies with the Human Rights Laws of NYS and federal statutes including Titles, VI, VII and IX.
Ø / What position are you applying for?
Ø / Have you ever been fingerprinted through the NYS Education Department? / Yes No
Ø / Have you ever been granted tenure in New York State? / Yes No
If yes, name of school:
Tenure Area: / Effective Date:
Ø / Have you served in the U.S. Military? / Yes No
Branch: / Dates of Service:

Certification/License (attach copies)

Subject/Grade Level / Type (temporary, permanent, etc.) / Number / Date Issued / State

To be included with this completed application:

r  Letter of Interest r Credentials from College Placement Office

r  Current Resume r Three Current Letters of Reference

r Copy of NYS Teaching Certificate(s) r Official College Transcripts from Registrar’s Office

Forward complete packet to:
Superintendent of Schools
300 College Avenue
Odessa, New York 14869

Education (“see resume” is not sufficient)

High School/GED / Graduated / Major / Type of Degree, Diploma or Certificate / Total Credit Hours
Yes / No
Undergraduate / Major / Type of Degree, Diploma or Certificate / Total Credit Hours
Graduate / Major / Type of Degree, Diploma or Certificate / Total Credit Hours

Teaching Experience (“see resume” is not sufficient)

Employer Name / Address / Phone # / Name of Supervisor / Employment Dates
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Position: / Grades/Subjects: / Reason for Leaving: / # of Years:
Employer Name / Address / Phone # / Name of Supervisor / Employment Dates
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Position: / Grades/Subjects: / Reason for Leaving: / # of Years:
Employer Name / Address / Phone # / Name of Supervisor / Employment Dates
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Position: / Grades/Subjects: / Reason for Leaving: / # of Years:
Employer Name / Address / Phone # / Name of Supervisor / Employment Dates
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Position: / Grades/Subjects: / Reason for Leaving: / # of Years:

Student Teaching Experience (“see resume” is not sufficient)

School Name / Location / Grade/Subject / Supervising Teacher / Dates
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End:
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Non-Teaching Work Experience (“see resume” is not sufficient)

Employer Name / Address / Phone # / Name of Supervisor / Employment Dates
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Job Title: / Work Performed: / Reason for Leaving:
Employer Name / Address / Phone # / Name of Supervisor / Employment Dates
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Job Title: / Work Performed: / Reason for Leaving:
Employer Name / Address / Phone # / Name of Supervisor / Employment Dates
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Job Title: / Work Performed: / Reason for Leaving:

References

Name / Position/Title / Address / Phone #
Please write a statement covering additional points which will help in judging your suitability for a position, including such things as: (1) your aims in teaching; (2) special experience, training or interests not mentioned elsewhere; (3) your teaching strengths and weaknesses. Attach additional pages if needed.
What aspect of teaching gives you greatest satisfaction? Why?
What recent innovations in education seem to be most exciting and promising? Why?

Ø  Have you ever been denied tenure or dismissed from a teaching position? Yes No

Ø  Have you ever resigned from a position rather than face disciplinary action? Yes No

Ø  Are you now, or have you ever been, affiliated with a group which advocates

a belief in opposition to the Constitution of the United States? Yes No

Ø  Have you ever been convicted of any crime, felony or misdemeanor? Yes No

Ø  Was an investigation conducted or pending at the time of separation

from prior employment? Yes No

I hereby declare that the information provided by me is true, factual, and complete. I understand that false or incomplete statements or misrepresentations may disqualify me for employment or cause my subsequent dismissal. If employed by the Odessa-Montour Central School District, I understand I may be required to supply additional personal information for the purpose of determining my eligibility for benefits and for statistical data. I acknowledge that nothing in this application or in the Odessa-Montour Central School District hiring process creates a contract of employment and the Odessa-Montour Central School District, should I obtain employment, retains its right to terminate my employment in accordance with the law. I hereby authorize the Odessa-Montour Central School District to verify my credentials and investigate me (including a DMV check and a consumer investigative report) as allowed by law. This verification process may include discussions with references I have listed, coworkers, friends, business associates and others who the Odessa-Montour Central School District, in its sole judgment, believes has relevant information. I will not make any claims against the District or persons the District may contact during the investigation of references and my application in general. I hereby release the District and such persons from any and all claims related in any way to such reference checks or investigation of my application in general.

Signature______Date______