Application for Employment

Please complete all requested information. Do not refer to resume.

Step 1 of 10

10%

A. Personal Data:
Name on Social Security Card*
Social Security Number

Not required at this time. Only Upon Job Offer.
You may enclose a personal resume if one is available and add any other information that may strengthen your application such as honors won, articles you have written, etc.
Accepted file types: doc, docx, pdf, jpg, jpeg, rtf, eps, tiff, png.
Address*

Street Address

City

State

ZIP Code
Phone*
When is the best day and time to reach you during the day?*
Email*

High School
Name & Location of Institution
Degree (if applicable)
College or University Under Graduate
Name & Location of Institution
Degree (if applicable)
College or University Graduate
Name & Location of Institution
Degree (if applicable)
List college credit earned since completing last degree
College or University Placement Office where your confidential papers are on file:

D. Record of Educational Experience

(For certified applicants only) Begin with most recent employment. A year of teaching is at least seven months of regular full-time teaching.
1. Name of School
Address

Street Address

Address Line 2

City

State

ZIP Code
From Date
To Date
No. of Years or Months
Grades, Subjects, Position
2. Name of School
Address

Street Address

Address Line 2

City

State

ZIP Code
From Date
To Date
No. of Years or Months
Grades, Subjects, Position
3. Name of School
Address

Street Address

Address Line 2

City

State

ZIP Code
From Date
To Date
No. of Years or Months
Grades, Subjects, Position
4. Name of School
Address

Street Address

Address Line 2

City

State

ZIP Code
From Date
To Date
No. of Years or Months
Grades, Subjects, Position

E. Student Teaching or Practicuum Experience

(For certified applicants only) List all areas and cooperating teachers.
1. Name of School
Address

Street Address

Address Line 2

City

State

ZIP Code
Area (Grade or Subjects)
Dates
Name of Cooperating Teachers
2. Name of School
Address

Street Address

Address Line 2

City

State

ZIP Code
Area (Grade or Subjects)
Dates
Name of Cooperating Teachers

F. Other Experience

(For all applicants) Begin with most recent employment and include U.S. military service.
1. Firm or Employer
Address

Street Address

Address Line 2

City

State

ZIP Code
Kind of Work
From Date
To Date
No. of Years
2. Firm or Employer
Address

Street Address

Address Line 2

City

State

ZIP Code
Kind of Work
From Date
To Date
No. of Years
3. Firm or Employer
Address

Street Address

Address Line 2

City

State

ZIP Code
Kind of Work
From Date
To Date
No. of Years
4. Firm or Employer
Address

Street Address

Address Line 2

City

State

ZIP Code
Kind of Work
From Date
To Date
No. of Years

F. Other Experience (contiuned)
Please include an explanation of all gaps in time of employment.
Other than vacation and holidays, how many days of work did you miss in the last two years?

G. References

List in the spaces provided at least three or more references (not relatives) including administrative and supervisory personnel who have first-hand knowledge of your performance and/or future potential in the area for which you are applying. Please be sure to provide both work and home numbers, since references are often not available at work numbers during certain times of the year.
1. Name*

First

Last
Address*

Street Address

Address Line 2

City

State

ZIP Code
Position
Home Phone Number
Work Phone Number
2. Name*

First

Last
Address*

Street Address

Address Line 2

City

State

ZIP Code
Position
Home Phone Number
Work Phone Number
3. Name*

First

Last
Address*

Street Address

Address Line 2

City

State

ZIP Code
Position
Home Phone Number
Work Phone Number
4. Name

First

Last
Address

Street Address

Address Line 2

City

State

ZIP Code
Position
Home Phone Number
Work Phone Number

Motor Vehicle Operator Applicants

If you are applying for a para-educator position which may require you to transport students. Please answer the following and provide any necessary explanation.
Do you have a current driver's license for the State of Kansas?*
How many years have you driven?*
Have you had any course or training to help you as a driver?*
Have you ever been denied a license to operate a motor vehicle?*
Has your moto vehicle license ever been suspended or revoked?*
Have you ever been convicted of driving under the influence of drugs or alcohol?*
How many accidents have you had while operating a vehicle over the past three years?*

Terms and Conditions

Your application will be filed according to the type of position(s) for which you are applying. You may inquire as to your employment status after you have supplied all requested information, including credentials (for certified applicants). NOTE: This application is valid for one year only from the date of application. Please notify us if you wish to keep this application on file. Requirements for Employment: If you are offered a contract, you must have an official transcript, credentials, a Kansas teacher’s certificate and a current health certificate on file with the Cooperative Office before you will receive payment under the contract. If you provide false, inaccurate or incomplete information in this application form or in any interview or if you fail to disclose informa- tion requested in this application or in any interview, you will not be eligible for employment, or, if you are hired, you will be subject to termination. I have completed this application to the best of my knowledge and do swear that all information stated herein is accurate and complete. I, the undersigned, hereby give my permission to East Central Kansas Cooperative in Education, Baldwin City, Kansas, to make job related inquiry of any and all employers and references listed in this application. Requirements for Employment: If you are offered a contract, you must have an official transcript, credentials, a Kansas teacher’s certificate and a current health certificate on file with the Cooperative Office before you will receive payment under the contract. If you provide false, inaccurate or incomplete information in this application form or in any interview or if you fail to disclose informa- tion requested in this application or in any interview, you will not be eligible for employment, or, if you are hired, you will be subject to termination. I have completed this application to the best of my knowledge and do swear that all information stated herein is accurate and complete. I, the undersigned, hereby give my permission to East Central Kansas Cooperative in Education, Baldwin City, Kansas, to make job related inquiry of any and all employers and references listed in this application.
Terms*
- Yes, I have read and agree to these terms.
Date*
Electronic Signature*

Type your full name here
Equal Opportunity Employer

Inter-Local #614 does not discriminate on the basis of sex, race, color, national origin, disability, or age when considering applicants for employment. Any questions regarding the Board’s compli- ance with Title VI, Title IX, Americans with Disability Act, or Section 504 may be directed to the local Title IX Coordinator, who can be reached at (785) 594-2737; 715 Chapel Street; Baldwin City, KS. 66006-0041, or the Kansas Title IX Coordinator who can be contacted at (785) 296-2424, 120 S.E. 10th Avenue; Topeka, KS. 66612-1182, or to the Assistant Secretary of Civil Rights, U.S. Department of Education.

Application for Employment

Step 1 of 10

A. Personal Data:

B. Employment Preference:

C. Academic & Professional Information:

Please list in order of preference the positions for which you are certified

High School

College or University Under Graduate

College or University Graduate

D. Record of Educational Experience

E. Student Teaching or Practicuum Experience

F. Other Experience

F. Other Experience (contiuned)

G. References

Motor Vehicle Operator Applicants

Terms and Conditions

Equal Opportunity Employer

July 2020
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