Seh 430

SCHOOL DISTRICT OF PHILADELPHIA OFFICE OF HUMAN RESOURCES 440 NORTH BROAD STREET PHILADELPHIA, PENNSYLVANIA 19130 (215) 400-4610

TO PR OSPECTIVE TEA CHER: PROSPECTIVE TEACHER: WE ARE PLEASED THAT YOU ARE INTERESTED IN EMPLOYMENT WITH THE SCHOOL DISTRICT OF PHILADELPHIA. WE HOPE THAT YOU ARE SUCCESSFUL IN OUR SELECTION PROCESS AND WILL BECOME PART OF THE TEAM HELPING OUR STUDENTS ACHIEVE THEIR FULLEST POTENTIAL. WE ARE IN THE PROCESS OF GATHERING STATISTICAL DATA REGARDING OUR RECRUITMENT EFFORTS. THEREFORE, WE ARE REQUESTING THAT YOU COMPLETE THE SURVEY BELOW. AFTER YOU HAVE FINISHED THE SURVEY, PLEASE COMPLETE THE APPROPRIATE INFORMATION IN SECTIONS 1, 2, 3, 4 AND 5, AND THEN PROCEED TO THE FOLLOWING PAGES. DATE OF SUBMISSION OF APPLICATION COLLEGE / UNIVERSITY ATTENDED

DATE GRADUATED

HOW DID YOU HEAR ABOUT THIS POSITION? (CHECK ONE) JOB FAIR NEWSPAPER AD PAREAP RECRUITER OTHER (Please specify) _______________________________

RECRUITMENT WORKSHOP SCHOOL DISTRICT JOB FLYER SCHOOL DISTRICT WEB SITE TEACHERS-TEACHERS.COM CURRENT SCHOOL DISTRICT EMPLOYEE (Referred by) Name:___________________________________ Position:___________________________ School or Location: ___________________________________________________________

YOU MUST SUBMIT THE ORIGINAL CRIMINAL RECORD CHECK AND PENNSYLVANIA CHILD ABUSE CLEARANCE AT THE TIME YOU ARE OFFERED EMPLOYMENT. THOSE CANDIDATES RESIDING OUTSIDE OF PENNSYLVANIA OR WITH LESS THAN TWO YEARS PENNSYLVANIA RESIDENCY MUST PRESENT A VALID FBI CRIMINAL CHECK. THESE DOCUMENTS ARE VALID FOR ONE YEAR AFTER THE DATE OF ISSUANCE. YOU CANNOT BE APPOINTED UNLESS YOU PRESENT THE ORIGINAL DOCUMENTS AT THAT TIME.

1. POSITION TITLE APPLIED FOR: 2. LAST NAME

FIRST NAME

M.I.

3. ARE YOU PROFICIENT IN ANY OTHER

DID YOU STUDENT TEACH WITH THE SCHOOL DISTRICT OF PHILADELPHIA?

LANGUAGE:

WORLD LANGUAGE BESIDES ENGLISH?

READ

WRITE

SCHOOL: ______________________________

SPEAK

4. ARE YOU CURRENTLY EMPLOYED BY THE SCHOOL DISTRICT OF PHILADELPHIA? YES, IF YES, CHECK ONE

NO

FROM:______________ TO: _______________

LONG-TERM SUBSTITUTE

NAME OF COOPERATING TEACHER(S)

REGULAR APPOINTMENT

PER DIEM SUBSTITUTE

_______________________________________

PROVISIONAL APPOINTMENT

APPRENTICE / LITERACY INTERN

_______________________________________

5. HAVE YOU EVER BEEN EMPLOYED BY THE SCHOOL DISTRICT OF PHILADELPHIA? IF “YES”, DATES OF EMPLOYMENT: REASON FOR LEAVING:

FROM

YES

NO

TO

FOR OFFICE USE ONL Y ONLY SCORE

RANK

SAD

PPAD

APPROVED

DISAPPROVED

CONDITIONAL ADMISSION TIE BROKEN BY: DATE

REMARKS:

SEH - 430 (10/03) Cover

INITIALS

STANDARD APPLICATION for Teaching Positions in Pennsylvania Public Schools (Please Type or Print)

POSITION(S) DESIRED__________________________________________________________ Name__________________________________________________________________________ Last

First

Social Security Number1

Middle

Present Address_______________________________________(____)_____________________ Street Telephone _______________________________________________________________________________ City State Zip

Permanent Address_____________________________________(____)_____________________ Street Telephone ____________________________________________________________________________ City State Zip

E-mail Address (if available___________________________________________ List, in order of preference, the grades, subjects and/or positions for which you are applying: 1.________________________ 2.________________________ 3.__________________________ CERTIFICATION (List all areas in which you hold valid Pennsylvania and/or out-of-state teaching certificates. Note: Applicants holding a certificate from another state must obtain a Pennsylvania Certificate in order to teach in Pennsylvania public schools.)

Area of Certification

Issuing State

Date Issued

Have you acquired tenure in Pennsylvania?_________. If yes, in what school district?_____________ _______________________________________________________________________________ Date available for employment___________________________ If you are not employed full time, are you interested in being placed on our Substitute List? ❑ Yes ❑ No Long-term ❑ Yes ❑ No Short-term ❑ Yes ❑ No 1 Federal Privacy Act [5 U.S. C. § 552a note] Statement. Authority for requesting social security account numbers:, Public School Code of 1949 [24 P.S. § 12-1212, 24 P.S. § 1224] Principal Purpose: To verify certification. Other Purposes: Identification and collection of criminal/disciplinary records for certified educators. Disclosure: Mandatory. Failure to provide the SSAN will result in an applicant not being considered for employment.

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