JEFF DAVISCOUNTYBOARD OF EDUCATION

P.O. Box 1780

Hazlehurst, Georgia 31539

Phone (912) 375-6700

APPLICATION OF

Name
Present Address / Phone
Permanent Address / Phone
Social Security No. / Date

FOR POSITION AS

(Administrator, Teacher, Media Specialist, Counselor, etc.)

(Indicate School, Grade, Subject, etc.)

The JeffDavisCounty Board of Education is an equal opportunity employer and does not discriminate in employment on the basis of race, color, sex, religion, national origin, age, handicap or disability.

Inquiries concerning the application of Title II, VI, IX or Section 504 and ADA to the policies and practices of the school system may be addressed to the Superintendent of Schools, Jeff Davis County Board of Education, 44 Charles Rogers Blvd., Hazlehurst, Georgia 31549, (912) 375-6700.

EDUCATION
NAME OF SCHOOL AND LOCATION
(Include High School, College, Graduate Work and Student Teaching in Order Taken) / DATES / HOURS
CREDIT / DEGREE
OR
DIPLOMA / MAJOR SUBJECT / MINOR SUBJECT
EXPERIENCE
NAME OF SCHOOL AND LOCATION / DATES / YEARS OR NUMBER OF MONTHS / NATURE OF WORK
If grades, specify what grades and subjects: If high school, the subjects taught and any extra curricular work handled
NON-EDUCATION EXPERIENCE
NAME OF BUSINESS AND LOCATION / DATES EMPLOYED / NATURE OF WORK
Title, field and expiration date of certificate(s) you hold:
(Include copy of certificate and college transcript)
If you have applied for certificate, include college transcript and letter from college verifying completion of certification requirements.
Are you presently under a teaching contract?
System / Date contract expires
Have you taken the Georgia TCT/PRAXIS I & II? Yes No Area
Score Report (Enclose a copy) Date passed
List college activities in which engaged and any honors received before or since graduation:
Write a brief paragraph providing additional information which you believe will assist in arriving at a true estimate of your qualifications. Please note any extracurricular activities, etc., that you would be interested in directing.
Please provide a copy of your evaluations (GTEP, GLEI, etc.) for last year, including your annual summary evaluation.
Evaluations included:Yes No N/A
Have you ever failed to have a contract renewed? If yes, attach an explanation.
Have you ever had a teaching credential denied, revoked, or suspended in any state? If yes, attach an explanation.
Have you ever been arrested, pleaded guilty or no contest to, or been convicted of any criminal offense other than a minor traffic offense?
Yes No If yes, please give detailed information on a separate sheet attached to this application as to each offense, including the specific offense for which you were charge, the disposition of the offense, and the date, court, county, and state where you were charged.
REFERENCES
These should be persons qualified to give an evaluation of your ability for the position you seek.)

Please include superintendents and principals under whom you have taught.

NAME /

ADDRESS/TELEPHONE

/

OCCUPATION

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2.
3.
4.
I understand and agree to a criminal record check as provided by Georgia Law, the policies and rules of the State Board of Education and of this Board of Education. I agree to be fingerprinted by the appropriate law enforcement officials, and I further agree to sign the forms which the law enforcement agency may require me to sign consenting to a criminal record check through the NationalCrimeInformationCenter and the GeorgiaCrimeInformationCenter. I understand I will be issued only a temporary contract of employment pending the outcome of a criminal record check.
I consent for any former employer of mine to furnish any information from my personnel file or evaluations relative to my performance as an employee, and I waive any right I may have for such information to remain confidential.
By filing application for employment with the Jeff Davis County School System, if employed, I agree to abide by all the policies as set forth by the Jeff Davis County Board of Education. I authorize full investigation of the information given in this application and consent to the representatives of the Jeff Davis County School System contacting my references, previous employers, schools attended, court officials and law enforcement authorities. I also understand that any misstatement or omission of any information requested shall be a reason for non-employment or dismissal from employment. The application, transcript, references, and other data are the property of the Jeff Davis County Board of Education and will not be returned to the applicant.
Notice: The furnishing of false or misleading information or the intentional withholding of material facts, including facts concerning one’s criminal record, will constitute ground for immediate termination.
Applicant’s Signature ______Date ______
JeffDavisCounty Board of Education Operates a Drug-Free Workplace