MAINE SCHOOL ADMINISTRATIVE DISTRICT NO. 64
P.O. Box 279,
Corinth, Maine 04427
Fax (207) 285-4343
THE M.S.A.D. NO. 64 DOES NOT DISCRIMINATE IN THE OPERATION OF ITS EDUCATIONAL AND EMPLOYMENT POLICIES AND WILL HONOR ALL APPROPRIATE LAWS RELATIVE TO DISCRIMINATION.
Name of applicant ___________________________________ Date ___________________
Permanent address___________________________________________________________
Temporary address ___________________________________________________________
Home phone __________________ Work phone ___________________
Position(s) applying for (Grade level, subject, other): ________________________________
________________________________
Are you currently employed? _________ When will you be available? _________________
EDUCATION: Transcripts, including grades, from all colleges/universities attended must be provided. It is essential that this section be completed accurately.
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College/ University |
Degree Awarded |
No. Years Attended |
Grade Point Average |
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Number of semester hours in:
_______ Reading __________Major (Subject _____________________)
_______ Math __________Minor (Subject _____________________)
_______ Special Education __________Major (Subject _____________________)
__________Minor (Subject _____________________)
CERTIFICATION: List certification(s) you hold and provide copy of certificates:
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Type & Endorsement |
State |
Date Issued |
Expiration Date |
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If you do not hold a Maine certificate, for what type of Maine certificate are you applying and eligible to receive? ___________________________________________________________________________
EXPERIENCE: A resume must be provided. In addition to educational background and work experience, include extra-curricular activities in which you have been involved. Please list below positions held, employer and dates of employment for the past ten years. Please account for any gaps in employment on a separate page.
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To (month/year) |
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Numbers of years of teaching experience __________
On a separate sheet of paper, please describe a specific class or class activity you planned and actually conducted which illustrates your philosophy of teaching and that you believe is the best example of your teaching skill. What evidence showed you that this class or activity was successful in terms of student motivation and achievement?
BACKGROUND:
Have you ever been disciplined, discharged, or asked to resign from
a prior position? Yes ___ No ___
Have you ever resigned from a prior position after a complaint had
been received against you or your conduct was under investigation or
review? Yes ___ No ___
Has your contract in a prior position ever been non-renewed? Yes ___ No ___
Have you ever not been nominated for re-employment in a prior
position or ever had your nomination for re-employment not
be approved? Yes ___ No ___
Have you ever been charged with or investigated for sexual
abuse or harassment of another person? Yes ___ No ___
Have you ever been convicted of a crime (other than a minor
traffic offense)? Yes ___ No ___
Have you entered a plea of guilty or “no contest” (nolo contendere)
to any crime (other than a minor traffic offense)? Yes ___ No ___
Have you ever had a professional license or certificate suspended
or revoked in any state, or have you every voluntarily surrendered,
temporarily or permanently, a professional license or
certificate in any state? Yes ___ No ___
Has any court ever deferred, filed or dismissed proceedings without
a finding of guilty and required that you pay a fine, penalty or
court costs and/or imposed a requirement as to your behavior or
conduct for a period of time in connection with any crime (other
than a minor traffic offense)? Yes ___ No ___
If you have answered YES to any of the previous questions, provide full details on an additional sheet including, with respect to court actions, the date and offense in question, and the address of the court involved. Conviction or other disposition of a crime is not necessarily an automatic bar to employment.
How many days have you missed from work during the past two years?_____________
REFERENCES: List three, two of whom are most recent supervisors, who can comment on your professional ability and whom we may contact. In addition, please provide three letters of reference from persons who are not related to you (may be from references listed below).
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Name |
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Address |
Phone |
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My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize those persons, agencies or entities that the M.S.A.D. No. 64 contacts in connection with my employment application to fully provide the M.S.A.D. No. 64 any information on the matters set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the M.S.A.D. No. 64, its agents or officials, or against any provider of such information.
I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include board members, administrators, other staff, and members of the community. I give my consent to this disclosure.
Signature _________________________________ Date _____________________
APPLICATION FOR TEACHING POSITION CHECK LIST: The completed employment application can not be evaluated unless of the following materials have been provided:
____ Application form fully completed
____ Copies of transcript(s)
____ Copy of Maine certification(s)
____ Resume
____ Gaps in employment during the past ten years explained
____ Illustration of your philosophy of teaching
____ YES to any of the questions in the Background section explained
____ Three letters of reference
____ Application signed
NOTE: All application materials become the property of the M.S.A.D. No. 64. None will be returned. Providing any false or misleading information on this application or in the application or employment screening process shall be fully sufficient grounds to refuse to employ the applicant or, if the applicant has been employed, to immediately dismiss the applicant/employee.