Certified Employment Application
1. Complete Application Form with your resume and letter of interest.
2. Copies of all university/college transcripts.
3. Professional Reference Forms Required. THESE MUST BE TURNED IN WITH THIS APPLICATION. List the names of reference writers below.
Name Position Location
a.
b.
c.
4. Placement Papers/Credential File OR three to five letters of recommendation.
(These letters of recommendation are separate from the Professional Reference Forms listed in No. 3.)
5. Biographical Sketch (300-500 words).
Comments:
Print Your Name
Signature Date
Applications will be kept on file for three years in the Human Resources Office. Unsolicited contact with district employees other than the Department of Human Resource Services may disqualify you from consideration for employment.
Complete Application:
Initial:
Department of Human Resource Services
Billings Public Schools
Billings Public Schools Web Site: www.billings.k12.mt.us
May 1, 2001
BILLINGS PUBLIC SCHOOLS
LINCOLN EDUCATION CENTER
415 North 30th Street • Billings, MT 59101-1298
(406) 247-3870 • Fax (406) 255-3560
13
PERSONAL INFORMATION Please Print or Type
Name SSN
Last First Middle
Other name(s) under which records may be listed
Present Address Telephone ( )
City State Zip Code
Permanent Address Telephone ( )
City State Zip Code
Name and telephone number of contact person
Current Employer Telephone ( )
Have you ever been terminated from a job? If yes, where and why?
Have you, since the age of 18 or within the last 7 years (whichever is more recent), been convicted of a felony? If yes, describe briefly.*
*A conviction will not necessarily bar an applicant from employment.
SIGNATURE RELEASE
The information I have provided in this application is true, correct, and complete. I authorize Billings Public Schools to contact former employers or references and obtain any and all information regarding my job-related background. I release and waive Billings Public Schools, my former employer(s), and all references from any and all liability to obtain or disclose such information. I agree that information provided by any individual will be confidential and I will not have access to such information. I agree that if I have provided false or incomplete statements, the District may, at its sole discretion, without notice or due process procedures, terminate my employment contract. If the District takes such action, the contract will be deemed void from its inception.
X
Signature of Applicant Date
EDUCATIONAL INFORMATION
OF SCHOOL / COURSE OF STUDY / NO. OF YEARS COMPLETED / DIPLOMA /
DEGREE
High School
Undergraduate
College
Undergraduate
College
Graduate / Professional
Other
(Specify)
CERTIFICATE/LICENSE INFORMATION
List all teaching, administrative, and special certificates issued by the State of Montana. Include a copy of your certificate(s) with your application.
Type of Certificate/License / Number / Endorsements / Issue Date / Expiration DateCERTIFIED TEACHING EXPERIENCE
List all contracted experience in order of occurrence. DO NOT list daycare, student teaching, or substitute teaching.
District Name / Grade/Subject / School Year / Full Time/Part Time / Reason for LeavingTo
To
To
To
LONG-TERM SUBSTITUTE EXPERIENCE
List in order of occurrence, all certified substitute teaching experience of at least 30 consecutive days in one assignment that occurred within the last two years.
District Name / Grade/Subject / School Year / Full Time/Part Time / Reason for LeavingTo
To
To
To
STUDENT TEACHING EXPERIENCE
List in order of occurrence your student teaching experience. DO NOT include other teaching experience in this section.
Name/Address of School / Grade/SubjectMaster Teacher / Principal / Dates
College / College Supervisor
Name/Address of School / Grade/Subject
Master Teacher / Principal / Dates
College / College Supervisor
OTHER WORK EXPERIENCE
List in order of occurrence military service, private sector, school-related employment, and volunteer service.
Location / Dates of Service / Position Title / General DutiesTo
To
To
To
TECHNOLOGY HISTORY
Please complete the following items as completely as possible.
Do you own a personal computer? If yes, what kind?
What computer/technology training have you had?
How have you used technology in your classroom?
Describe your software experience and skill level below.
Program Type / Identify Program Name / Skill LevelProficient / Basic / None
Word Processing
Spreadsheet
Data Base
Grading
Internet
Presentation
Instructional Software
CREDIT INFORMATION
List below an estimate number of credit hours that you have earned in each area.
SECTION 1--Elementary (K-6) (Quarter Hrs. /Semester Hrs. )
SUBJECT / HRS. / SUBJECT / HRS. / SUBJECT / HRS. / SUBJECT / HRS.Art / Math Manipulative / ECE (Early Childhood Ed) / Math
Library / Reading Specialists / Multicultural Awareness / Science
Counselor / Technology / Language Arts / Social Studies
Physical Education / Special Education / Music
SECTION 2—Secondary (7-12) (Quarter Hrs. /Semester Hrs. )
SUBJECT / HRS. / SUBJECT / HRS. / SUBJECT / HRS. / SUBJECT / HRS.Art / Spanish / Multicultural Awareness / Chemistry
French / Traffic Safety / Math / Earth Science
Counselor / Biology / Music / German
Economics / Library / Reading Specialists / Technology
Health / Drama / Industrial Arts / Latin
Journalism / English / Special Education / Business
Library / Home Economics / Math Manipulative / Social Studies
Physics / Language Arts / Physical Education
ACTIVITIES
Indicate activity positions in which you are interested. If interested in coaching, list sports and level of competition, and complete an Activities Application, available in the Human Resources Office.
Activity / Grade Level / Activity / Grade LevelPERSONAL REFERENCES
Give names and complete addresses of references that are familiar with your professional work and qualifications. Do not include personal friends or relatives.
NAME / ADDRESS / PHONENUMBER / OCCUPATION
All references listed above will be contacted.
POSITION SELECTIONS
Select from the list of positions below, the one(s) for which you wish to be considered. Write the code letter and number of your selected position(s) beside the number that indicates the order of your selection(s) from 1 to 5, with 1 being of highest priority, up to 5 selections. You must hold (or anticipate being eligible to obtain) appropriate certification for the position(s) you designate.
1. 2. 3. 4. 5.
13
13
13
GRADE K-6 POSITIONSKindergarten / E000 / Band / M450
Grade 1 / E001 / Physical Education / P600
Grade 2 / E002 / Librarian / L400
Grade 3 / E003 / Preschool / I540
Grade 4 / E004 / Adaptive PE / I690
Grade 5 / E005 / Deaf/Hearing Impaired / I640
Grade 6 / E006 / Self-Contained / I644
Art / E030 / Resource Room / I600
Counselor / C550 / Emotional/Behavioral / I679
Music / M450 / English Second Lang. / E770
GRADE 7-8 POSITIONS
Art / M030 / Earth Science / G720
English / G090 / Physical Education / P600
Reading / G690 / Technology / G751
Librarian / L400 / Adaptive PE / I690
Home Economics / G330 / Deaf/Hearing Impaired / I640
Math / G420 / Self-Contained / I644
Algebra / G421 / Emotional/Behavioral / I679
Counselor / C550 / Resource Room / I600
History / G750 / Band / M450
Life Science / G740 / Orchestra / M450
Geography / G730 / Choral / M480
GENERAL POSTIONS
(Certificate/License Required)
Audiologist / N080 / Occupational Therapist / N920
Speech Lang. Path / N800 / Psychologist / N660
Physical Therapist / N960 / Social Worker / N760
School Nurse / N640 / English Second Lang. / N790
GRADE 9-12 POSITIONS
Art / H030 / Biology / H830
French / H410 / Chemistry / H831
German / H450 / Physics / H833
Latin / H690 / Physical Science / H832
Spanish / H870 / General Science / H834
Russian / H810 / Earth Science / H720
Health Education / H480 / Social Studies / H854
Counselor / C550 / Political Science / H851
Industrial Arts / H970 / History / H750
Auto Mechanics / H270 / Geography / H751
Electronics / H350 / Economics / H853
Graphics/Tech / H910 / Sociology / H852
Journalism / H373 / Technology / H320
Speech / H372 / Traffic Safety / H950
Drama / H371 / Home Economics / H510
English / H090 / Trade/Industry / H540
Librarian / L400 / Agriculture / H250
Math – Algebra / H421 / Business / H270
Calculus / H633 / Vocational Education / I650
Geometry / H634 / Resource Room / I600
Music – Band / M450 / Self-Contained / I644
Orchestra / M450 / Deaf/Hearing Impaired / I640
Choral / M480 / Adaptive PE / I690
Physical Ed / P600 / Emotional/Behavioral / I679
13
DATE
Name (Last) (First) (Middle)
SSN Area(s) of Certification
DIRECTIONS: Please answer each of the questions given below as best you can. The space provided should be adequate, but if more space is needed please attach additional pages.
1. What do you want to accomplish as a teacher?
2. How will (do) you go about finding out about students' attitudes and feelings about your class?
3. An experienced teacher offers you the following advice: “When you are teaching be sure to command the respect of your students immediately and all will go well.” How do you feel about this?
4. How do you go about deciding what it is that should be taught in your class?
5. A parent comes to you and complains that what you are teaching his child is irrelevant to the child's needs. How would you respond?
6. What do you think will (does) provide you the greatest pleasure in teaching?
7. When you have some free time, what do you enjoy doing the most?
8. How do you go about finding what students are good at?
9. Would you rather try a lot of wayout teaching strategies or would you rather try to perfect the
approaches which work best for you? Explain your position.
10. Do you like to teach with an overall plan in mind for the year, or would you rather just teach some interesting things and let the process determine the results? Explain your position.
11. A student is doing poorly in your class. You talk to her, and she tells you that she considers you to be the poorest teacher she has ever met. What would you do?
12. If there were absolutely no restrictions placed upon you, what would you most want to do in life?
Professional Reference Form
APPLICANT’S NAME: has applied for a certified position.
How long have you known this applicant? What school year(s) did you observe this applicant?
Where? And in what capacity did the applicant work with you?
What was your title at the time? In what capacity did you evaluate this applicant? As supervisor/evaluator How long? As colleague How long?
REFERENCE WRITER PLEASE NOTE: Please rate this applicant on a scale of 1 to 5, with 1 being low and 5 being high, in each of the following factors. Compare this individual to all others you have observed. Check only one box per factor.
FACTORS / Low1 / 2 / 3 / 4 / High
5 / Not
Observed
1. Classroom Management. Effectively manages large and small groups and individuals; creates an atmosphere conducive to learning by developing routines and procedures to increase learning.
2. Behavioral Management/Discipline. Establishes and uses appropriate behavior management procedures; recognizes conditions which may lead to discipline problems; establishes clear parameters for student behavior; develops strategies to prevent discipline problems; responds appropriately when problems occur; assists students toward self-discipline.
3. Flexibility. Willing to learn new concepts and ways of doing things; cooperates with youth and adults; effectively uses various teaching styles; successfully teaches a variety of assignments; adapts to others in a team, staff, or parent situation.
4. Instructional Skills. Plans, implements, and evaluates instructional activities; has knowledge of and applies current approaches to teaching new ideas and skills; uses a variety of styles/methods which reflect planning and pacing skills appropriate to students; monitors results and takes appropriate action; assesses students’ needs, prescribes programs, and provides strategies appropriate to age, background, and intended learning of students.
5. Commitment to Accomplishments for Self and Others. Establishes high expectations for self and students; exerts effort to attain goals; organizes, predicts, and monitors ideas, time, materials, and space to cause achievement to take place.
6. Relation to Students. Develops favorable relationships with students; exhibits empathy and responds to student needs; listens, has patience, and demonstrates caring; accepts students as they are; is considered open and approachable by students; works collaboratively with students in decision making.
7. Understands/Appreciates Multicultural and Diverse Populations. Relates positively to youth and adults from varying socioeconomic, cultural, racial/ethnic backgrounds, different learning styles, and various disabilities; adjusts classroom activities to reflect the diversity of students.
8. Scholarship and Conceptual Skills. Demonstrates ability to: learn new ideas and skills for substantive and methodological aspects of teaching, learn initial information necessary to function in the local setting, apply new concepts during teaching, and solve problems.
9. Attendance. Exhibits positive work habits that demonstrates a caring and warmth toward students and an enthusiasm for learning. Uses organizational skills to enhance and motivate student learning. Uses work attendance not only as a personal tool but also as an example to students.
10. Professional Orientation/Collaboration. Possess an awareness of current educational developments and their applications, including learning, child development, and approaches to teaching; demonstrates a willingness to work collaboratively at the building and district level, effectively building relationships and responding positively to constructive comments and supervision; holds a strong belief in the importance of education; sincerely interested in the welfare of all students and in solving problems by consensus.
11. Technological Literacy. Makes appropriate use of available technology in relation to planning activities, learning activities, and record keeping; integrates technology into the learning process.
Print Name Signature
Address Date