Safford Unified School District
734 W. 11th Street
Safford, AZ 85546
APPLICATION
AN EQUAL OPPORTUNITY EMPLOYER
Mr.Mrs.MissMs.Dr. / Application Date:Title / Last / First / Middle
Address:
Street / City / State / Zip Code
Home Phone: / Cell Phone: / E-Mail:
Driver’s License Number: / State: / Expiration Date: / Type:
Social Security Number:
Position(s) for which you are applying:
Revised 5/12
Revised 5/12
Education and TrainingList school attended and special training received.
High School / Address/Phone / Dates Attended / Year Graduated / Degree / Major Area of Study
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College / Address/Phone / Dates Attended / Year Graduated / Degree / Major Area of Study
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Arizona teaching certificates held:
Revised 5/12
Revised 5/12
In what areas are you highly qualified?Revised 5/12
Revised 5/12
Describe additional training not listed above (i.e., trade schools, business schools, etc.):Revised 5/12
Work ExperienceStart with your most recent position.
Please include all work experience below even if a resume is submitted, LEAVE NO BLANKS.
Dates Employed
Month/ Year / Employer’s
Name/Address/Phone / Supervisor’s Name / Reason for Leaving / Position Held
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List additional work experience not listed above:
Please explain any gaps in employment if longer than three (3) months.
Describe any experience you have had that makes you a strong candidate for this position:
List the reasons why you are applying for this position:
If you are applying for a teaching position, what extra-curricular or coaching duties would you be willing to sponsor?
Personal References
Give name, complete address and phone number of three references who are familiar with your personality, character and work habits. (Do not use relatives as references.)
Name / Dates Known
(provide month & year) / Occupation / Address / Phone Number
Have you ever been dismissed from a position? Yes No
If yes explain:Conviction Report
Because of the responsibility Safford Unified School District has to its school children and community, the following information is needed from all applicants and employees regarding conviction. A record of conviction does not necessarily disqualify applicant from consideration; however, failure to complete this form accurately and completely may mean disqualification from consideration for employment or may be a cause for consideration of dismissal if employed and may result in prosecution for filing false information with a public agency. Applicants and employees must report any considerations that occur subsequent to the time they initially completed this form. Questions regarding information should be directed to the Superintendent. Please read carefully and answer every question.
Yes / No
Have you ever been convicted of a minor offense other than a traffic violation?
Have you ever been convicted of a felony?
Are you now awaiting trial on a felony charge?
Have you ever been convicted of a sex or drug related offense?
Have you ever been admitted or been convicted of a dangerous crime against children as defined in A.R.S. 13-604-01?
Is there any other information not required by this application that you should disclose to the Superintendent so that it may accurately evaluate your fitness to work in a position of public trust with minor students?
If you are uncertain as to the relevance or necessity to disclose a matter, trait, etc., please discuss with the Superintendent and he will determine whether or not the information is pertinent. If you answer yes to any of the above, attach a letter of explanation.
CONVICTION means the final judgment on a verdict or a finding of guilty, a plea of guilty, or plea of not contendere, in any state or federal court of competent jurisdiction in a criminal case, regardless of whether an appeal is pending or could be taken. Conviction DOES NOT include a final judgment which has been expunged by pardon, reversed, set aside, or otherwise rendered invalid. **A.R.S. 13-604.01 required applicants to give notice of any conviction for dangerous crimes against children. These crimes are defined as second degree murder, aggravated assault, sexual assault, molestation of a child, sexual conduct with a minor, commercial sexual exploitation of a minor, sexual exploitation of a minor, child abuse, kidnapping, and sexual abuse.
Applications for certified positions will be kept on file for a period of one year. If you wish to continue to have your name on the active file, it will be necessary for you to complete a new application after one year.
Applications for classified positions will be kept on file for a period of six months from date of filing. If you wish to continue to have your name on the active file, it will be necessary for you to complete a new application after six months.
CERTIFICATION:
All teaching certificates are issued by the Arizona Department of Education. No teacher may be placed in the classroom or receive a salary until a bona fide teaching certificate is issued by the State Department and registered with the County Superintendent of Schools in the county where such certificate is to be used.
RETIREMENT:
All public school employees must participate in the Arizona State Retirement System and the Federal Social Security Plan. Both plans call for contributions by the individual and the employer.
EMPLOYMENT REQUIREMENTS: Upon employment, the following must be met:
ELIGIBILITY STATUS: Immigration and Reform and Control Act of 1986 (IRCA) requires proof of work eligibility be provided.
IMMUNIZATION RECORDS: Arizona State Department of Health Services (regulations R9-729 and R9-742) require proof of immunization for Measles and Rubella be provided unless the employee falls within one of the exceptions as per District policy.
SELECTIVE SERVICE REGISTRATION: Arizona Revised Statue 38-201D requires individuals who need to be registered with the Selective Service provide their Selective Service number, local board number, city and state registered.
Under penalty of prosecution and dismissal, I hereby certify that the information presented on this application is true, accurate and complete.
I authorize the investigation of all statements contained herein and understand that any document relevant to this information may be reviewed by the Superintendent and other administrators of Safford Unified School District.
I authorize Safford Unified School District to make reference checks prior to employment and I will execute such documents to facilitate this investigation. I understand that my employment is not finalized until the background investigation has been completed and the Governing Board has officially approved my employment. I understand that misrepresentation or omission of pertinent facts may be cause for dismissal.
Signature (if NOT electronically submitted) Date
INTERVIEWS WILL BE HELD WITH FINAL CANDIDATES
Please send current resume and transcripts with certified applications.
Return this form to: Superintendent of Schools
734 W. 11th Street
Safford, AZ 85546
Or E-Mail to
Thank you for your interest in applying for position(s) in Safford Unified School District.
If you have any questions, please call the Superintendent’s Secretary at (928) 348-7007.