Okmulgee Public Schools

316 East Eighth - P. O. Box 1346, Okmulgee, Oklahoma 74447

Telephone: (918) 758-2000, Fax: (918) 758-2088

NOTE: If mailing the application and attachments you might want to consider sending by certified mail.

You will know by your return receipt that the application has arrived: Mail to the Attention of “Personnel Department”.

“AN EQUAL OPPORTUNITY EMPLOYER”

Okmulgee Public School District 56I-001adheres to the principle and practice which prohibits discrimination in the admission, recruitment, selection and/or employment on the basis of race, religion, color, gender, age, national origin, veteran status or disability condition.

APPLICATION FOR CERTIFIED POSITION

A.PERSONAL INFORMATIONApplication Date______

NAME:______ SOCIAL SECURITY NUMBER:______

LASTFIRSTMIDDLE

PRESENT ADDRESS:______

STREET CITY STATE ZIP

PERMANENT ADDRESS:______

STREET CITY STATE ZIP

PHONE NO:______ARE YOU 18 YEARS OR OLDER? Yes  No 

PERSON TO BE NOTIFIED IN CASE OF ACCIDENT OR EMERGENCY:

______

Name Address Phone Number Relationship

ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OF IMMIGRATION STATUS? Yes  No 

HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES  NO 

B.EMPLOYMENT PREFERENCE:

1.Type of Application

a. Full Time only  b. Temporary, Part-time, or Substitute only  c . Either a or b 

2.Kind of employment (complete only those areas for which you can qualify and in which you could accept employment).

a. Elementary School Teacher

(1) List grade level preference: (a)______(b)______(c)______(d)______

(2) List other subjects you are qualified to teach:

(a)______(b)______(c)______(d)______

b. Middle School

(1) Major teaching field______

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

(a)______(b)______(c)______(d)______

(2) Minor teaching field______

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

(a)______(b)______(c)______(d)______

c. High School

(1) Major teaching field______

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

(a)______(b)______(c)______(d)______

(2) Minor teaching field______

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

(a)______(b)______(c)______(d)______

d. Professional School-Service Employee (Administrator, Counselor, Librarian, Nurse, etc.) ______

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C.EDUCATION PREPARATION:

Education / Kind of Degree / Date of Graduation / Major / Major
GPA / Name of Institution / Location
1. High School
2. Jr. College
3. Bachelors
4. Masters
3. Doctorate

College Minor(s)______

Total College Hours______

Intern Teaching: a. Completed  b. Taking  c. None 

If you have completed intern teaching within the last 3 years or are now taking it, please fill in the following:

Name of Cooperating Teacher______School______

Grade or Subjects taught______Date Completed______

D.EMPLOYMENT RECORD :

1. Have you ever been employed by this school district? a. Yes  b. No 

If the above response is “yes”, complete the following:

a. Inclusive dates of such employment ______

b. Your name during the period of employment, if changed since then______

2.Total years experience in an accredited school under contract as a teacher______

3.List below a complete chronological history of teaching or professional-school service and other work experience. Include a supplementary sheet if space is inadequate. Begin with the most recent experience in each category.

Teaching or Professional-School Service Experience
Name of School / Street, City, State, Zip / Assignment / Beginning Date / Ending Date / Reason For Leaving
Other Work Experience
List Military Service, if any, then account for employment experience other than teaching or professional-school service:
Employer / Street, City, State, Zip / Position / Beginning Date / Ending Date / Reason For Leaving

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E:REFERENCES:

1.Professional References: In naming references, give preference to supervisors, principals, and other educators who are familiar with your professional work. Addresses for each reference must be complete.

Name / Present Address
Street, City State, Zip / Position of Reference when he/she knew of your work and years known / Phone Number
1.
2.
3.
4.
5.

Indicate name and address of any College or University Placement Bureau in which you are registered:

______

Is the College or University forwarding your placement folder: Yes  No 

2.Personal References:PLEASE DO NOT USE FAMILY MEMBERS

Name / Present Address
Street, City State, Zip / Occupation
Years known / Phone Number
1.
2.
3.

3.If you are known to any professional or personal reference by any other name than the name you have shown on this application, provide your former/other name and astrict(*) the name of the reference you have listed above

______

Former/Other Name

F:ATTACHMENTS TO APPLICATION:

Make available the following items if they not been provided:

RESUME

TRANSCRIPT OF COLLEGE CREDITS. If the transcript is incomplete because your are currently enrolled in school, attach to the incomplete transcript a list of those courses and the semester hours to be earned.

 OKLAHOMA TEACHING CERTIFICATE

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G.INTERVIEW:

If you are selected for an interview you will be contacted by the Administration Center to arrange an interview.

This application will serve as your request to add your name to our list of applicants.

I understand that my application will remain active for the present school year. Information contained with this application will be treated confidentially until such time you may be employed by Okmulgee Public Schools, at which time, this application and the information contained therein become records covered by the Okmulgee Public Schools Open Records Policy and may be released under this regulation.

H.INFORMATION FOR APPLICANT:

1.CERTIFICATION:

Only those teachers holding valid Oklahoma Teaching Certificates in their field of preparation may be considered for employment. It is the responsibility of the applicant to become certified to teach.

2.REQUIREMENT:

The following requirements must be completed and on file within the first 20 days of employment to insure continued employment.

a.Certificate

A valid Oklahoma Teaching Certificate in the field of preparation must be on file at the Administration Center.

b.Transcripts

A transcript of completed college or university work should be filed with the application. Those signing contracts will need and additional official copy of their transcript showing the degree granted.

c.Teacher Retirement Forms

d.Loyalty Oath

e.W-4 Tax Forms

3.PREVIOUS EXPERIENCE:

Experience to be evaluated for salary purposes would include:

a.Experience from an accredited school as a teacher, supervisor, or administrator.

b.Active service in the Armed Fores of the United States confirmed with Form DD-214.

4. EMPLOYMENT

All inquiries regarding vacancies should be directed to the Administration Center - NOT individual schools within the Okmulgee Public School system.

I.AGREEMENT:

I hereby certify that the information herein is to the best of my knowledge true, accurate, and complete. Any misrepresentation or willful omissions of facts shall be sufficient cause for disqualification of this application or termination of employment. Furthermore, it is understood that this application and records become the property of the Okmulgee Public Schools which reserves the right to accept or reject it. I further agree to observe all rules, regulations, and policies of the school district, if employed. All first-time and non-continuing certified employees hired by Okmulgee Public Schools shall be placed on a temporary contract.

______

Signature of Applicant

I hereby authorize the school district to conduct work history, personal reference, and a background check to determine my acceptability for employment.

______

Signature of Applicant

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