CERTIFIED STAFF APPLICATION
COMANCHE COUNTY USD 300
600 E. Garfield, PO Box 721, Coldwater KS 67029
620-582-2181
APPLICATION FOR EMPLOYMENT CERTIFIED STAFF
DATE: __________
POSITION DESIRED: ________________
Each applicant for a certified position in the Comanche County Schools will complete and return this application. Please include your complete transcript with this application and notify your teacher placement office to forward a copy of your credentials to this office.
PERSONAL INFORMATION
Last Name____________________ First Name______________________ MI_____ Preferred Name______________________
Mailing Address_______________________ City_____________________ State_______________ Zip Code_____________
Home Phone_______________ Cell Phone_______________ E-mail Address________________________________________
Are you over 18 years of age? Yes______ No______ If not, employment is subject to verification of minimum legal age.
Are you related to a member of the Board of Education? Yes______ No______
Relationship: Father___ Mother___ Brother___ Sister___ Spouse___ Son___ Daughter___ Son-in-Law___ Daughter-in-Law___
Do you have any impairment, physical or mental, which would interfere with your ability to perform the job for which you are
applying? Yes______ No______ If yes, please explain job duties you cannot perform because of the impairment: ___________
PROFESSIONAL INFORMATION
Provide information about your teaching certificate you now hold.
State Issuing Certificate:____________________________
Date Issued:_______________ Date of Expiration:_______________
Level/Subject(s):__________________________________________________________________________________________
Check activities you are competent and willing to direct or coach: Basketball___ Cheerleading___ FCCLA___ Football___
Forensics___ Golf___ Honor Society___ Scholars Bowl___ Student Council___ Tennis___ Track___ Volleyball___
Other, __________________________________________________________________________________________
Are you under contract for the present school term? Yes______ No______ If yes, when does this contract expire? ____________
Do you have home obligations or other duties which might interfere with your accepting any assignments, or which would prevent your attendance at meetings outside of regular school hours? Please explain:____________________________________
________________________________________________________________________________________________________
How did you learn of the school district? ______________________________________________________________________
List professional or civic memberships: (Exclude those which disclose your race, color, religion, national origin or sex)
________________________________________________________________________________________________________
TEACHING/ADMINISTRATIVE EXPERIENCE
Please list experiences as an educator for the past ten years with the most recent position first.
1. SCHOOL:_____________________________________________________________________________
ADDRESS:____________________________________________________________________________
TELEPHONE:_________________________________________________________________________
ASSIGNMENT: TEACHING______________________ADMINISTRATIVE______________________
EMPLOYED (MONTH/YEAR) FROM:______________________ TO:___________________________
LEVEL AND/OR SUBJECT:______________________________________________________________
2. SCHOOL:_____________________________________________________________________________
ADDRESS:____________________________________________________________________________
TELEPHONE:_________________________________________________________________________
ASSIGNMENT: TEACHING______________________ADMINISTRATIVE______________________
EMPLOYED (MONTH/YEAR) FROM:______________________ TO:___________________________
LEVEL AND/OR SUBJECT:______________________________________________________________
3. SCHOOL:_____________________________________________________________________________
ADDRESS:____________________________________________________________________________
TELEPHONE:_________________________________________________________________________
ASSIGNMENT: TEACHING______________________ADMINISTRATIVE______________________
EMPLOYED (MONTH/YEAR) FROM:______________________ TO:___________________________
LEVEL AND/OR SUBJECT:______________________________________________________________
4. SCHOOL:_____________________________________________________________________________
ADDRESS:____________________________________________________________________________
TELEPHONE:_________________________________________________________________________
ASSIGNMENT: TEACHING______________________ADMINISTRATIVE______________________
EMPLOYED (MONTH/YEAR) FROM:______________________ TO:___________________________
LEVEL AND/OR SUBJECT:______________________________________________________________
We may contact the employers listed above unless you indicate those you do not want us to contact.
Do not contact: #____ Reason:____________________________________________________________________
EDUCATION
COLLEGE UNDERGRADUATE
Name of School:___________________________________________________________________________________
Location of School:________________________________________________________________________________
Teaching Field(s):_________________________________________________________________________________
Did you graduate: Yes______ No______ Degree:________________________________________________________
COLLEGE GRADUATE
Name of School:___________________________________________________________________________________
Location of School:________________________________________________________________________________
Teaching Field(s):_________________________________________________________________________________
Did you graduate: Yes______ No______ Degree:________________________________________________________
MILITARY-COMPLETE THIS SECTION IF YOU SERVED IN THE U.S. ARMED FORCES
Branch of Service:______________________________________________________________________________
Period of active duty(Month/Year) From:___________________________ To:______________________________
Rank at Discharge:______________________________________________________________________________
Date of Final Discharge:_________________________________________________________________________
REFERENCES
NAME ADDRESS POSITION TELEPHONE
1. ______________________________________________________________________________________
2. ______________________________________________________________________________________
3. ______________________________________________________________________________________
4. ______________________________________________________________________________________
5. ______________________________________________________________________________________
PHILOSOPHY OF EDUCATION
State in 75 to 100 words your Philosophy of Education
SIGNATURE
Signature_________________________________________________ Date________________________________
Comanche County USD 300 does not discriminate on the basis of race, color, national origin, sex, age or handicap in admission or access to, or treatment or employment in its programs and activities. If you have questions regarding the above, please contact the Superintendent of Schools, 600 E. Garfield, Coldwater, KS 67029, 620-582-2181,
Title IX, and section 504 Coordinator
