Application Template Certificated
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Middle Name
CERTIFICATED EMPLOYMENT APPLICATION Human Resources Services 44711 North Cedar Avenue Lancaster, California 93534 661-948-4661
First Name
Position(s) for which you are applying (Grade and/or Subject)
Name
Social Security Number
( Street Address
)
Telephone (Home)
City/State/Zip Code
)
Telephone (Other)
Education and Professional Training Institution of Higher Education
Dates Attended
Units Sem/Qtr
Major
Degree or Certificate
Date Conferred
Semester units of graduate work beyond BA or BS degree (1-Quarter Unit equals 2/3 Semester Unit) BA
BA+15
BA+30
BA+45 or MA
MA+15 or BA+60
MA+30 or BA+75
Awards, Honors, Scholarships, etc., which you feel relate to this position:
An Equal Opportunity-Affirmative Action Employer
Lancaster School District
PRINT NAME HERE:
Last Name
(
What languages other than English can you speak? List extra-curricular activities you participated in college.
List Professional, Technical, Educational, Community, or Service Organizations to which you belong. (Omit religious, racial, or ethnic organizations)
Please complete the following fitness questions. If you answer “yes” to any question, please attach a full explanation using a separate sheet of paper. Have you ever been dismissed, retired, resigned from, suspended for more than ten Yes No days, or otherwise left school employment because of allegations of misconduct? Have you ever been convicted, including a conviction based on a plea of no contest, of any felony or misdemeanor in California or any other place?
Yes
No
Have you ever been or are you currently the subject of any inquiry or investigation by any licensing agency or law enforcement agency (in California or any other state)?
Yes
No
Have you ever been convicted of any moving traffic violations?
Yes
No
Are any criminal charges currently pending against you?
Yes
No
Is any disciplinary action now pending against you in any school district?
Yes
No
Credential Information: Have you passed all sections of the CBEST test?
Yes
No
Do you hold a valid California Credential?
Yes
No
Yes
No
Yes
No
Have you passed subject matter competency? (MSAT/CSET)
Yes
No
Have you ever had any credential, including, but not limited to, any Certificate of Clearance, permit, credential, license, or other document authorizing public school service or teaching, privately admonished within the past three years, publicly reproved, suspended, revoked, voided, selfrevoked, and/or otherwise subjected to any other disciplinary action in California or any other place?
Yes
No
Have you ever had any application for a credential, including but not limited to, any Certificate of Clearance, permit, credential, license, or other document authorizing public school service or teaching, denied and/or rejected for cause in California or any other state or place?
Yes
No
Type of Credential
Expiration Date of Credential
Do you hold a valid California Teaching Permit?
Type of Permit
Expiration Date of Permit
Are you currently enrolled in a teacher preparation program? (If yes, please complete the following)
Institution of Higher Education
Credential Program
I certify that all statements on this application are true to the best of my knowledge. I understand that false statements shall be sufficient cause for dismissal or disqualification from employment consideration.
Signature of Applicant
Date
Your employment application should include: Lancaster School District application Resumé (include Professional and Personal References) Copy of transcripts Copy of your teaching credential Letters of reference (no more than three) If you have any questions, please contact Human Resources Services. Telephone: E-mail:
(661) 948-4661 Extension 151 [email protected]
CERTIFICATED EMPLOYMENT APPLICATION Human Resources Services 44711 North Cedar Avenue Lancaster, California 93534 661-948-4661
First Name
Position(s) for which you are applying (Grade and/or Subject)
Name
Social Security Number
( Street Address
)
Telephone (Home)
City/State/Zip Code
)
Telephone (Other)
Education and Professional Training Institution of Higher Education
Dates Attended
Units Sem/Qtr
Major
Degree or Certificate
Date Conferred
Semester units of graduate work beyond BA or BS degree (1-Quarter Unit equals 2/3 Semester Unit) BA
BA+15
BA+30
BA+45 or MA
MA+15 or BA+60
MA+30 or BA+75
Awards, Honors, Scholarships, etc., which you feel relate to this position:
An Equal Opportunity-Affirmative Action Employer
Lancaster School District
PRINT NAME HERE:
Last Name
(
What languages other than English can you speak? List extra-curricular activities you participated in college.
List Professional, Technical, Educational, Community, or Service Organizations to which you belong. (Omit religious, racial, or ethnic organizations)
Please complete the following fitness questions. If you answer “yes” to any question, please attach a full explanation using a separate sheet of paper. Have you ever been dismissed, retired, resigned from, suspended for more than ten Yes No days, or otherwise left school employment because of allegations of misconduct? Have you ever been convicted, including a conviction based on a plea of no contest, of any felony or misdemeanor in California or any other place?
Yes
No
Have you ever been or are you currently the subject of any inquiry or investigation by any licensing agency or law enforcement agency (in California or any other state)?
Yes
No
Have you ever been convicted of any moving traffic violations?
Yes
No
Are any criminal charges currently pending against you?
Yes
No
Is any disciplinary action now pending against you in any school district?
Yes
No
Credential Information: Have you passed all sections of the CBEST test?
Yes
No
Do you hold a valid California Credential?
Yes
No
Yes
No
Yes
No
Have you passed subject matter competency? (MSAT/CSET)
Yes
No
Have you ever had any credential, including, but not limited to, any Certificate of Clearance, permit, credential, license, or other document authorizing public school service or teaching, privately admonished within the past three years, publicly reproved, suspended, revoked, voided, selfrevoked, and/or otherwise subjected to any other disciplinary action in California or any other place?
Yes
No
Have you ever had any application for a credential, including but not limited to, any Certificate of Clearance, permit, credential, license, or other document authorizing public school service or teaching, denied and/or rejected for cause in California or any other state or place?
Yes
No
Type of Credential
Expiration Date of Credential
Do you hold a valid California Teaching Permit?
Type of Permit
Expiration Date of Permit
Are you currently enrolled in a teacher preparation program? (If yes, please complete the following)
Institution of Higher Education
Credential Program
I certify that all statements on this application are true to the best of my knowledge. I understand that false statements shall be sufficient cause for dismissal or disqualification from employment consideration.
Signature of Applicant
Date
Your employment application should include: Lancaster School District application Resumé (include Professional and Personal References) Copy of transcripts Copy of your teaching credential Letters of reference (no more than three) If you have any questions, please contact Human Resources Services. Telephone: E-mail:
(661) 948-4661 Extension 151 [email protected]
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