Faculty Application Form Page 3

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DRIVING RECORD
Driver’s License No.__________________________ CDL License No.____________________________
Endorsements ______________________________
List traffic violations you received in last 36 months (other than parking violations):
____________________________________________________________________________________________________________
Date of Violation
Offense
Location
___________________________________________________________________________________________________________
Date of Violation
Offense
Location
____________________________________________________________________________________________________________
Date of Violation
Offense
Location
EDUCATION
________________________________________________________________________________________________
Name of School
Address of School
Dates attended
Major
Degree
____________________________________________________________________________________________________________
Name of School
Address of School
Dates attended
Major
Degree
____________________________________________________________________________________________________________
Name of School
Address of School
Dates attended
Major
Degree
____________________________________________________________________________________________________________
Name of School
Address of School
Dates attended
Major
Degree
____________________________________________________________________________________________________________
Name of School
Address of School
Dates attended
Major
Degree
a.____________________________________________________
___________________
Subject
Semester Hours
a.____________________________________________________
___________________
Subject
Semester Hours
a.____________________________________________________
___________________
Subject
Semester Hours
Overall undergraduate grade point average
________
Maximum possible (i.e. 3.0, 4.0) ___________
___________
Overall graduate grade point average
________
Maximum possible (i.e. 3.0, 4.0)
Scholastic honors:_________________________________________________________________________________________
TEACHER CERTIFICATION
A valid Florida certificate must be recorded in the President’s office.
Florida certificate number _________________________
Date issued___________________
Expiration date________________
Subjects on certificate_______________________________________________________
Note: 1) In accordance with federal law, verification of eligibility for employment is required at the time of interview; 2) forward
transcripts immediately; 3) finger printing in the Sheriff’s Office or other appropriate location is a condition of employment.
EXTRA-CURRICULAR ACTIVITIES
Are there any areas, i.e. coaching, that you have prior experience?__________________________________________________
__________________________________________________________________________________________________________

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