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WOODLAWN

PUBLIC SCHOOLS PUBLIC SCHOOLS

Certified Application

Woodlawn School District

6760 Hwy. 63

Rison, AR 71665

Phone (870)357-8108 Fax (870)357-8718

Applicants for employment are accepted without regard to sex, race, color, national origin, physical/mental handicap, age, religion, or political affiliation. Conviction of a crime does not automatically bar any applicant from employment with our school.

Instructional and Administrative Application

Name

Position Desired

Date

Reaquired field: Present Address

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Phone Number

Birthdate

In Case of Emergency Notify

Relation

Phone

Are you a U.S. citizen?

Reaquired field: Yes

Reaquired field: No

If not, are you a Legal Alien?

Yes

Have you ever been convicted of a crime/felony?

Reaquired field: Yes

Reaquired field: No

If yes, please explain

Are you currently listed on the child maltreatment registry?

Reaquired field: Yes

Reaquired field: No

References

Please list four references; include superintendents and principals under whom you have worked.

Reference 1 Name and Position

Reaquired field: Reference 1 Information

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reference 1 email

Reference 1 phone

Reference 2 Name and Position

Reaquired field: Reference 2 Information

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reference 2 email

Reference 2 phone

Reference 3 Name and Postion

Reaquired field: Reference 3 Information

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reference 3 email

Reference 3 phone

Reference 4 Name and Position

Reaquired field: Reference 4 Information

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reference 4 email

Reference 4 phone

Educational and Professional Training

High School, include City and State

Date Attended/Graduated

College, include City and State

Date Attended

Graduation Date and Degree

Total Hours

Graduate Work

Date Attended

Graduation Date and Degree

Total Hours

Undergraduate Major

Undergraduate Minor

Graduate Major

Graduate Area of Specialization

College activities in which you have participated

Internship

School District

Date

Grade/Subject Taught

Principal

Supervising Teacher

Do you hold an Arkansas Teaching Certificate?

Reaquired field: Yes

Reaquired field: No

Expiration Date

Type

Regular

Provisional

Level

Subjects qualified to teach as listed on Teaching License

Teaching Experience

List annual salary of last teaching position held

Activities you would be willing to sponsor

By submitting this application, I agree to the following statements.

I authorize investigation of all statements contained in this application. I understand misrepresentation or omission of facts is cause for dismissal without notice at any time during my employment. I agree, if employed, to follow all rules and regulations of the district. I understand, by state law, the board of education must require all employees to submit a health certificate from a physician along with a tuberculin test, at my expense. I agree to promptly notify the district of any change of address during my employment.

Email a copy to

optional

Required Fields