FAIRFIELD BOARD OF EDUCATION
6405 AVENUE D
FAIRFIELD, ALABAMA 35064
APPLICATION FOR CERTIFIED POSITION
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| DATE:
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TYPE OF POSITION FOR WHICH APPLYING:
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If Services is selected, please specify skill area
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GENERAL INFORMATION |
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SOCIAL SECURITY NUMBER:
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LAST NAME:
FIRST NAME:
MIDDLE:
MAIDEN:
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STREET:
CITY:
STATE:
ZIP:
TELEPHONE (ex: 205-555-5555):
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| SPOUSE (For identification and Retirement purposes only) |
| LAST NAME:
FIRST NAME:
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| Have you ever been arrested or convicted?
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EDUCATIONAL DATA |
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- COLLEGE:
CITY:
STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
MAJOR:
DEGREE:
- COLLEGE:
CITY:
STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
MAJOR:
DEGREE:
- COLLEGE:
CITY:
STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
MAJOR:
DEGREE:
- COLLEGE:
CITY:
STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
MAJOR:
DEGREE:
- COLLEGE:
CITY:
STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
MAJOR:
DEGREE:
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OTHER FORMAL TRAINING :
CITY:
STATE:
LAST YEAR ATTENDED :
GRADUATE:
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STUDENT TEACHING EXPERIENCE (WITHIN LAST FIVE YEARS): (IF APPLICABLE) |
- SCHOOL:
GRADE/SUBJECT:
FROM(ex: mmddyy):
TO(ex: mmddyy):
SUPERVISING TEACHER:
- SCHOOL:
GRADE/SUBJECT:
FROM(ex: mmddyy):
TO(ex: mmddyy):
SUPERVISING TEACHER:
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EMPLOYMENT |
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ARE YOU CURRENTLY EMPLOYED?
IF YES, WHERE?
MAY WE CONTACT YOUR EMPLOYER?
PAST?
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PROFESSIONAL EXPERIENCE IN EDUCATION |
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- EMPLOYER:
CITY/STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
GRADES and/or SUBJECT :
- EMPLOYER:
CITY/STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
GRADES and/or SUBJECT :
- EMPLOYER:
CITY/STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
GRADES and/or SUBJECT :
- EMPLOYER:
CITY/STATE:
FROM(ex: mmddyy):
TO(ex: mmddyy):
GRADES and/or SUBJECT :
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EXTRA CURRICULAR ACTIVITIES YOU ARE WILLING TO DIRECT |
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- ACTIVITY:
EXPERIENCE:ELEMENTARY:
HIGH SCHOOL:
- ACTIVITY:
EXPERIENCE:ELEMENTARY:
HIGH SCHOOL:
- ACTIVITY:
EXPERIENCE:ELEMENTARY:
HIGH SCHOOL:
- ACTIVITY:
EXPERIENCE:ELEMENTARY:
HIGH SCHOOL:
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CERTIFICATION |
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- STATE:
AREA(S) OF CERTIFICATION :
EXPIRATION DATES :
- STATE:
AREA(S) OF CERTIFICATION :
EXPIRATION DATES :
- STATE:
AREA(S) OF CERTIFICATION :
EXPIRATION DATES :
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| HAVE ALL REQUIREMENTS FOR ALABAMA CERTIFICATION BEEN COMPLETED:
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| IF YES, WHEN? FROM(ex: mmddyy):
TO(ex: mmddyy):
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| IF ALABAMA CERTIFICATE NOT HELD, HAS APPLICATION BEEN MADE?
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| IF YES, PLEASE GIVE DETAILS:
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| DO YOU HAVE ANY RELATIVES EMPLOYED WITH THE FAIRFIELD BOARD OF EDUCATION?
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| IF YES, PLEASE LIST : |
- NAME (ex: last, first) :
POSITION:
WHERE EMPLOYED:
- NAME (ex: last, first) :
POSITION:
WHERE EMPLOYED:
- NAME (ex: last, first) :
POSITION:
WHERE EMPLOYED:
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PERSONAL REFERENCES - Please include current or last supervisor |
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| PLEASE LIST THREE PROFESSIONAL REFERENCES WHO ARE FAMILIAR WITH YOUR WORK, ONE MUST BE LAST OR CURRENT SUPERVISOR. |
- NAME (ex: last, first) :
TITLE:
CITY:
STATE:
TELEPHONE (ex: 205-555-5555):
- NAME (ex: last, first) :
TITLE:
CITY:
STATE:
TELEPHONE (ex: 205-555-5555):
- NAME (ex: last, first) :
TITLE:
CITY:
STATE:
TELEPHONE (ex: 205-555-5555):
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COMMENTS BY APPLICANT |
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Resume:
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DIGITAL SIGNATURE |
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****I CERTIFY THAT THE INFORMATION I HAVE GIVEN ON THIS APPLICATION IS TRUE AND COMPLETE**** |
| APPLICANT SIGNATURE (ex: last, name)
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| IT IS THE OFFICIAL POLICY OF THE FAIRFIELD BOARD OF EDUCATION THAT NO PERSON SHALL BE DISCRIMINATED AGAINST ON THE GROUNDS OF THEIR RACE, COLOR, HANDICAP, SEX, RELIGION, CREED, NATIONAL ORIGIN, OR AGE. |
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