Summer Opportunities 2018

Hamilton School District

Teacher Application

Summer Opportunities 2018

Name:

Home Address: Phone:

City: State: Zip:

School Name and Address:

Email Address:

Summer Opportunities Experience:

Course Taught: Year(s):

Course Taught: Year(s):

Indicate the grades and subject area in which you currently hold Wisconsin Certification:

I am interested in teaching the following course/courses during the Hamilton Summer Opportunities program:

Choice #1:

Choice #2:

Are you proposing to teach a new Summer Opportunities course?yes no

(include class name, grade level(s) and a course description on a separate sheet of paper)

Are you proposing to change the course description to the Summer Opportunities brochure? yes no

(include new course description on a separate sheet of paper)

Please note: Student enrollment will determine whether or not a Summer Opportunities course will be able to run. Most courses run three sections, starting at8:30, 9:30 and 10:30, Monday through Friday. Each section must have a minimum of 15 students per teacher for it to run, with a few exceptions.

Are you willing to possibly teach a course that is not one of your first two choices? yes no

Are you willing to possibly teach only 1 or 2 sectionsif your course does not fill? yes no

Do you prefer to have a Teaching Assistant if one is available?(student minimum of 15/section required) yes no

Submit application to:

Renee MysliwskiPhone:(262) 255-3653 – Summer Opportunities office

Lannon Elementary SchoolFax:(262) 255-4185

7145 N. Lannon Road

Lannon, WI 53046-0376

Have you ever been convicted, plead nolo contendere or no contest to any offense or violation other than minor traffic violations (include felonies, misdemeanors, or municipal ordinance violations): yes no

List all pending charges for such violations:

Read and Sign

I authorize the Board of Education of the Hamilton School District to make any inquiry of or receive information from any person or organization regarding my suitability for employment; and do hereby give permission to these persons or organizations to provide such information. Such inquiries may include and not be limited by enumeration to the quality and quantity of my work, work history and record, character, qualifications, records or convictions and medical records. For and in consideration of the release of such information, I hereby forever waive, release, and covenant not to sue any person or organization including the Hamilton School District, its agents and employees for the result of providing, obtaining, or acting upon such information. I give this waiver, release, and covenant not to sue for myself, my heirs, assigns, and successors in interest forever. I give this waiver, release, and covenant not to sue understanding that the information obtained may be such as to disqualify me for employment, I understand that such information is sought with confidentiality, and I will not request copies of such information. I also certify that all statements made on this application are true and complete, accurate, and not misleading to the best of my knowledge. I understand that any false statements, incomplete statements, or misrepresentations may subject me to disqualification or dismissal. A copy of this authorization shall be effective as the original.

SignatureDate