CERTIFIED (TEACHER) APPLICATION
UNIFIED SCHOOL DISTRICT #247
506 SOUTH SMELTER
CHEROKEE, KS 66724
USD #247, Cherokee, KS, does not discriminate on the bases of race, color, national origin, sex, handicap, or age in admission or access to, or treatment of employment in, its programs or activities. Any questions regarding compliance with Title VI, Title IX, or Section 504 may contact at the above address:
Glenn Fortmayer, 620-457-8350 (Title IX Coordinator or Section 504 Coordinator)
Last First Middle
Mailing Address: ____________________________________________________
Date of Candidate’s Availability: ________________________________________
Date of Application: ____________________
Apply for teaching position in: K-6 _____ 7-8 _____ 9-12 _____
Rank your preference regarding subject(s) you wish to teach:
1. __________ 2. __________ 3. __________ 4. __________
Extra curricular activities you wish to direct: _____________________________
1. Is there any position(s) for which you should not be considered or job duties
you can not perform? _____________________________________________
2. Do you have any contagious or communicable diseases which may endanger
3. Have you even been convicted of a felony? Yes ____ No _____
4. Are you a citizen of the U.S.A.? _____ If not, are you an alien lawfully
authorized to work in the United States? _____
1. High School Attended:
2. College Training in Chronological Order:
School Attended & Inclusive Degree (and Major Minor
Location Dates /or) Hours Field Field
3. Number of Semester Hours since attaining your last degree:
Undergraduate Graduate .
4. College Honors and Activities:
1. Current Employment:
2. Are you now under contract? If so, when does your contractual
3. Do you currently hold, or are you qualified for a teaching certificate in Kansas?
If so, state:
a. Issue and Expiration Dates:
b. Endorsements on Certificate:
4. Chronological Teaching Record:
School Name and Location Teaching Duties Dates Monthly Salary
5. Professional Memberships:
6. College Placement Bureau where your credentials are available:
7. List the names and address of your past two immediate supervisors:
Name Position Address and Telephone Number
8. Other Work Experience:
Employer and Location Duties Date of Employment
1. State briefly your reasons for wishing to be a teacher in our district.
2. Please mention here anything not included elsewhere in This application which you feel will
further support your candidacy.
APPLICANTS JOBB APPLICATION ACKNOWLEDGEMENTS
1. I CERTIFY THAT ALL THE INFORMATION PROVIDED BY ME IN THIS
APPLICATION IS TRUE AND COMPLETE. I UNDERSTAND THAT ANY
MISSTATEMENT, FALSIFICATION, OR OMISSION OF INFORMATION IS
GROUNDS FOR REFUSAL TO HIRE OR, IF I AM HIRED AND THE SAME IS
DISCOVERED THEREAFTER, TERMINATION.
2. I AUTHORIZE ANY OF THE PERSONS OR ORGANIZATIONS REFERENCED IN
THIS APPLICATION TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY
PREVIOUS EMPLOYMENT, EDUCATION, OR ANY OTHER INFORMATION, PERSONAL
OR OTHERWISE, WITH REGARD TO ANY OF THE SUBJECTS COVERED BY THIS APPLICATION, AND I RELEASE ALL SUCH PARTIES FROM ALL LIABILITY FOR ANY DAMAGES THAT MAY RESULT FROM FURNISHING SUCH INFORMATION TO YOUR. I AUTHORIZE ANY BACKGROUND CHECKS BY ANY THIRD PART.
3. I AUTHORIZE YOU TO REQUEST, RECEIVE, AND VERIFY ALL INFORMATION GIVEN ON THIS APPLICATION AND I RELEASE YOU FROM ALL DAMAGES THAT MAY RESULT FROM YOUR DOING SO.
4. I AUTHORIZE YOU TO CONDUCT A CRIMINAL BACKGROUND INVESTIGATION USING ANY AND ALL METHODS NECESSARY TO SUCCESSFULLY COMPLETE SUCH INVESTIGATION AND I RELEASE YOU FROM ALL LIABILITY FOR ANY DAMAGES THAT MAY RESULT FROM YOUR DOING SO.
Signature of Applicant: Date:
Letter of Application
Kansas Teaching Certificate