Employment Application For Certified Personnel - Acadia Parish School Board Page 2

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EDUCATION

All Colleges and Universities attended must be listed. (DO NOT state "refer to resume.")

Name and Address of College/University

Area(s) of Specialization

Dates Attended

Degree Received

TEACHING EXPERIENCE

List teaching experience beginning with the most recent. DO NOT list student teaching. Credit for teaching out-of-state is allowed for public school teaching service only. DO NOT list other out-of-state experience.

Dates

Grade, Subject, or

Number of Years (If less than

From

Name and Full Address of Employer

Other Assignment

one year, state number of

days.)

REFERENCES

(Examples: Superintendent, Supervisor, Dean of College, Professor or Teacher with whom you did student teaching or practicum.)

Name

Official Position

Address and Telephone Number

IT IS MANDATORY THAT YOU ANSWER THE FOLLOWING QUESTIONS. FALSIFICATION OF ANY AREA OF THIS APPLICATION WILL RENDER BOTH THE APPLICATION AND ENSUING CONTRACT

NULL AND VOID.

- Did you participate in the Louisiana New Teacher Assistance and Assessment Program? ____Yes ____No

If so, did you successfully complete the program? ____Yes ____No When?________________________ Where?___________________________________________________

- Have you ever been arrested and/or convicted of a crime? ____Yes ____No

If yes, explain in detail. ____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

I hereby authorize the Acadia Parish School Board to request evaluation results as a part of the application process in Accordance with R.S. 17:391.5H. (This applies to certified teachers

only. I hereby certify that information given by me in this application is true and complete to the best of my knowledge.

Date:___________________________________

Signature:__________________________________________________________________________________

COMPLETE APPLICANT FILE IS MAINTAINED FOR ONE YEAR ONLY. It is the applicant's responsibility to update his/her file by completing a new application.

ALL BLANKS MUST BE FILLED IN FOR THIS APPLICATION TO BE VALID.

Return completed application to: Ellan Kay Baggett, Supervisor of Personnel, Acadia Parish School Board, P. O. Drawer 309, Crowley, LA 70527-0309

PUBLIC NOTICE

: The Acadia Parish School Board adheres to the equal opportunity provisions of Federal civil rights laws and regulations that are applicable to this Board. Therefore, no one will be discriminated against on the basis of race, color, national origin (Title VI of

the Civil Rights Act of 1964); Sex (Title IX of the Education Amendments of 1972); handicapping conditions (Section 504 of the Rehabilitation Act of 1973), or veterans status in the pursuit of educational goals and objectives and in the administration of personnel policies and

procedures.