Licensed Application

Licensed Application
Employment Application for Licensed Positions
Rush City Schools is an Equal Opportunity Employer

Applicant: We sincerely appreciate your interest in our school district and assure you that your application will be given careful consideration. A clear understanding of your educational background and employment history will assist us in evaluating your qualifications for this position. Please take care to provide all of the requested information on this application form. DO NOT WRITE "SEE RESUME."

 

Position for which you are applying:
Area(s) of licensure:
Subject, grade(s), or level you prefer (in order of preference):
Extra-curricular events you are interested in leading/directing:

Name

First:  
Middle:  
Last:  
Address:   
City:Phone (daytime):
State:Phone (evening):
Zip:Phone (cell):
E-mail:

Have you ever been convicted for violation of the law other than a minor traffic ticket?

(If yes, please give full details here.)

Do you have the legal right to work in the United States?

Are you a Minnesota resident?

If yes, have you been a continuous Minnesota resident for the past seven years?

NOTICE TO ALL APPLICANTS: In accordance with the Immigration Reform and Control Act of 1986, it is unlawful for the School District to knowingly hire any person who is not authorized to work in the United States. In compliance with this statute, it is our intent to hire only authorized workers. All successful applicants for employment will be asked to verify that they are a United States citizen or an alien authorized to work in the United States. As a condition of continued employment, new employees will be asked to provide such verification as required by law within three (3) business days after the date of hire.

Authorization for Background/Reference Check:

I give permission to Rush City Schools to make inquiries of references and former employers concerning my general character and past performance. I also give permission for the District to request a character reference check and/or criminal history check from law enforcement agencies, the Bureau of Criminal Apprehension, or other screening agencies, if they wish to do so. I understand that the school district may permit me to commence my employment duties pending completion of the criminal history background check, but that I may be dismissed based on the results of that check. I authorize the agency receiving such request to give full and complete information as may be requested by Rush City Schools. I understand that the information will be treated as confidential by the District. (Note: Failure to sign this authorization may disqualify you from consideration for employment.)

Please provide information regarding all current and previous disciplinary actions in Minnesota and other states involving sexual misconduct or attempted sexual misconduct with a student. Attach additional page(s) or documents if needed. Intentionally submitting false or incomplete information is grounds for dismissal.

Education: Full information and dates are required.

Schools AttendedName and LocationMajorMinorDiploma
or Degree
Did You
Graduate?
High School
College/University
Graduate School
Other
What was your grade point average in college:Major:
 Minor:
 Overall
Do you hold a valid professional license from the MN Department of Education in the area for which you have applied?
(If no, please explain.)

Please give information below regarding your licensure. 
Subject, Grade, or Area of LicensureTeaching MajorsTeaching MinorsIs your License Current?

 

List below any licensure held (vocational, coaching, W.S.I., etc.)

List college activities and honors received before or since graduation

List volunteer activities you have been involved with, including offices or positions held, length of involvement, and the level and nature of your responsibilities

Please state any previous or current military experience

Student Teaching/Internship Information: (applicants with more than two years of relevant experience do not need to complete this section).
Name of School and City in Which
Student Teaching was Done
Student Teaching was Done Name of
Supervising Teacher
Grade or
Subjects Taught
No. of
Months
Hours per
Week

Employment History: Please provide a complete history of your work experience. This information is used to determine your qualifications for positions in our School District; therefore, please provide complete, detailed information. If your teaching experience has not been continuous, indicate in detail what your occupation or activity was during the time you were not teaching.

Please list your current or most recent employer first. Include dates for the last five (5) years only.

 

I.
Name of Employer:Grade/Subjects Taught or Title of Position:
City and State:Name of Principal/Supervisor & Phone:
Date From:Total Time:
Date To:Full TimePart Time 
Last Salary:   
Reason for Leaving:    
Duties and Responsibilities:    

 

 

II.
Name of Employer:Grade/Subjects Taught or Title of Position:
City and State:Name of Principal/Supervisor & Phone:
Date From:Total Time:
Date To:Full TimePart Time 
Last Salary:   
Reason for Leaving:    
Duties and Responsibilities:    

 

 

III.
Name of Employer:Grade/Subjects Taught or Title of Position:
City and State:Name of Principal/Supervisor & Phone:
Date From:Total Time:
Date To:Full TimePart Time 
Last Salary:   
Reason for Leaving:    
Duties and Responsibilities:    

 

 

IV.
Name of Employer:Grade/Subjects Taught or Title of Position:
City and State:Name of Principal/Supervisor & Phone:
Date From:Total Time:
Date To:Full TimePart Time 
Last Salary:   
Reason for Leaving:    
Duties and Responsibilities:    

 

V.
Name of Employer:Grade/Subjects Taught or Title of Position:
City and State:Name of Principal/Supervisor & Phone:
Date From:Total Time:
Date To:Full TimePart Time 
Last Salary:   
Reason for Leaving:    
Duties and Responsibilities:    

 

References: Please give names and current addresses and phone numbers for supervisors or others who know of your work experience and can speak to your qualifications for this position.
NameCurrent AddressCurrent PhoneRelation to Your Work
    
    
    

 NOTICE TO ALL APPLICANTS:

I certify that all information provided on this application and attached documents is true, complete and correct to the best of my knowledge and belief. I understand my statements are subject to verification and that falsification on this application will disqualify me from employment or result in dismissal. I further understand that it is my responsibility to submit any changes in my availability, phone number, and address to the District in writing.

Important Facts About Information On Your Application

This application is to assist in the process of referring you to our schools and departments for possible employment. Certain information requested on the application is private; that is, it may be released only to you or to schools/department where you may be considered for employment (in compliance with M.S. 15.165.Subd.2). If you are employed by the district, the data will be available to the Payroll Department, the Internal Revenue Service, and the Social Security Administration for payroll and tax purposes.

Private DataWhy We Ask For ItAre You Legally Obliged to Provide It?
NameTo Distinguish you from all other applicantsYes
AddressTo be able to send you notices and other correspondence.Yes
Phone NumberTo be able to contact you to determine availability for interviews.No
Sex, Race/Ethnicity, Disability StatusTo enable us to make Equal Opportunity reports as required by law and to evaluate our recruitment efforts.No
Conviction RecordTo determine whether we may legally accept your application and to determine whether your record may be a job-related consideration.Yes

All other information on the application is public; that is, it may be given to anyone for any purpose.

 

 

 



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