ACS Certified Employees Application Form


Applicant Demographics:

Last Name:
First Name:
Middle Name:
Temporary Street:
Temporary City:
Temporary Zip:
Temporary Phone:
Permanent Street:
Permanent City:
Permanent Zip:
Permanent Phone:
If Previously employed by ACS, list when:


Teaching Certificate:
Subjects or grades certified to teach:
Kind of Certificate:
Valid in what state:
Certification Serial No:
Certification expiration date:
Remarks:


Teaching Preference in Area of Certification

(List in order of preference):
Elementary Preference 1:
Elementary Preference 2:
Elementary Preference 3:
Secondary Preference 1:
Secondary Preference 2:
Secondary Preference 3:
Other Preference 1:
Other Preference 2:
Other Preference 3:
Preference type:
Date Available for Employment:


Training
Secondary Major 1:
Secondary Major 2:
Secondary Minor 1:
Secondary Minor 2:
Secondary Extra-Curricular 1:
Secondary Extra-Curricular 2:
Secondary Extra-Curricular 3:
Secondary Extra-Curricular 4:


Select subjects you are certified
to teach and sports you
are willing to coach

(Select all that apply)
Arts Crafts:
Business:
Foreign Language:
Home Economics:
Industrial Arts:
Language Arts:
Math:
Music:
Science:
Social Studies:
Phys Ed:
Extra-Curricular areas you would wish to participate in:
Special Education:
Special Area:

List education above 9th grade through college

Institution 1:
Location:
Date Attended:
Total Years:
Year Graduated:
Degree Earned:

Institution 2:
Location:
Date Attended:
Total Years:
Year Graduated:
Degree Earned:

Institution 3:
Location:
Date Attended:
Total Years:
Year Graduated:
Degree Earned:

Institution 4:
Location:
Date Attended:
Total Years:
Year Graduated:
Degree Earned:


Teaching Experience

(List all the places you have taught, last place first)
Teaching Experience School 1 (Name & Address):
Number of Years:
From Date:
To Date:
Teaching Assignment:
Reason for Leaving:

Teaching Experience School 2 (Name & Address):
Number of Years:
From Date:
To Date:
Teaching Assignment:
Reason for Leaving:

Teaching Experience School 3 (Name & Address):
Number of Years:
From Date:
To Date:
Teaching Assignment:
Reason for Leaving:

Teaching Experience School 4 (Name & Address):
Number of Years:
From Date:
To Date:
Teaching Assignment:
Reason for Leaving:

Teaching Experience School 5 (Name & Address):
Number of Years:
From Date:
To Date:
Teaching Assignment:
Reason for Leaving:

Teaching Experience School 6 (Name & Address):
Number of Years:
From Date:
To Date:
Teaching Assignment:
Reason for Leaving:


Active Military Service:
Discharge Type:
Branch of Service:
Induction Date:
Separation Date:


Professional Status:
Have you ever been terminated from a teaching position?:
Where Terminated:
Reason Terminated:
Have you received an unsatisfactory teaching evaluation in the past 3 years:
Evaluation Explanation:
If registered with college placement, list college & address:
Optional Information:

References:

(List Name, Address, Telephone, and Occupation)

Reference Contact Info 1:
Reference Contact Info 2:
Reference Contact Info 3:
Reference Contact Info 4:

List Individuals whom you know personally employed by the Anderson Community Schools:

ACS Employee Reference 1:
ACS Employee Reference 2:
ACS Employee Reference 3:
ACS Employee Reference 4: