Date Received________________

Lavaca Public Schools

P.O. Box 8

Lavaca, Arkansas 72941

Application for Certified Positions

Position applying for:__________________________________

Last Name:_____________________________

First Name:_____________________________

Middle Name:___________________________

Social Security Number:___________________

Phone Number (Primary):__________________

Phone Number (Secondary):________________

Address:__________________________________________________________

E-mail Address:____________________________________________________

Have you previously been employed by Lavaca Public Schools? Yes____ No____

If yes, when and in what position?:_________________________________

Date available for employment:__________________

Are you a citizen of the U.S.? Yes____ No____

Have you ever been convicted of a felony? Yes____ No____

Have you ever been released or asked to resign? Yes____ No____

If yes, please explain________________________________________________

_______________________________________________________________________

Are you presently employed? Yes____ No____

If yes, where and in what position?___________________________________

Why do you wish to leave? _________________________________________

Education

Undergraduate

Institution	Dates Attended	Major Subjects	Minor Subjects	Degree Earned

Graduate

Institution	Dates Attended	Degree Earned

Do you hold an Arkansas Teaching Licensure? Yes____ No____

If yes, what type? Regular____ Provisional_____

Areas and levels of licensure: _____________________________________

_____________________________________

Expiration Date:____________

Please list any special training:____________________________________________

_____________________________________________________________________

Experience

Please list all educational field work history first.

Institution	City, State	Position	Grade	Date	Reason for Leaving

Professional/Personal References

Please list 5 references including those from previous work history.

Name	Position	Address	Phone Number	Years Known

Why would you like to work for Lavaca Public Schools?________________________

________________________________________________________________________

Please state your philosophy of the role of the school: __________________________

________________________________________________________________________

Are you a Highly Qualified Teacher for the position for which you are applying? Yes____ No____N/A____

In order for your application to be considered, you must enclose the following:

All College Transcripts
Copy of Teaching Certificate
Resume
Praxis scores and/or proof of High Qualified Status
This Application Signed and Dated

Signed:___________________________________________________

Date:_____________________