Untitled-3

Application for Teaching in the

Williamson Central School

Date: _________________________________

Send your application to:

Maria Ehresman, Superintendent

P.O. Box 900

Williamson Central School

Williamson, New York 14589

Telephone: (315) 5899661

Web Site: www.williamsoncentral.org

Position Applying for: _______________________________

Position(s) desired:

(List in order of preference)

1. ______________________________________________

2. ______________________________________________

3. ______________________________________________

Name: __________________________________________________________________________________

Last

First

Middle

Present Address: _________________________________________________________________________

Number

Street

Telephone

________________________________________________________________________________________

Town

State

Zip

Permanent Address: _______________________________________________________________________

Number

Street

Telephone

________________________________________________________________________________________

Town

State

Zip

Email Address: ___________________________________________________________________________

Certification Areas: ________________________________________________________________________

Certificate Number: _____________________________ Social Security Number: _____________________

NYS Retirement Number: ___________________________________________________________________

Certificate of Qualification:

______ Yes ______ No

Date Granted _______________

(Attach Copy)

Provisional Certification:

______ Yes ______ No

Date Granted _______________ (Attach Copy)

Permanent Certification:

______ Yes ______ No

Date Granted _______________ (Attach Copy)

If no Certification, what is your status? _________________________________________________________

Have you ever failed at reappointment? _________________________ or for Tenure? __________________

Are your fingerprints registered with SED? ______ Yes ______ No

Law Violation: Except for minor traffic violation, have you ever been convicted of any violation of Law? ______

If yes, please attach a complete explanation.

WILLIAMSON CENTRAL SCHOOL DOES NOT DISCRIMINATE REGARDING AGE, SEX, CREED, RACE, COLOR, NATIONAL ORIGIN

OR HANDICAPPING CONDITIONS AND IS IN COMPLIANCE WITH TITLE IX AND HUMAN RIGHTS LEGISLATION. THE TITLE IX AND

SECTION 504 COMPLIANCE OFFICER CAN BE REACHED AT THE WILLIAMSON C.S.D. (315) 5899661.

II.

EDUCATIONAL HISTORY

__________________________________________________________________________________

No. Years

Location

Attending

Diploma/

Name of Institution

City, State

Full Time

Major

Degree

__________________________________________________________________________________

Honors and awards received, articles published: _________________________________________________

________________________________________________________________________________________

List educational travel, committee work, and leadership experiences you have had: ______________________

________________________________________________________________________________________

Date available for employment: ________________________________________

III.

EXPERIENCE

(List student teaching if no other teaching experience)

________________________________________________________________________________________

No. of Years

School & Address

Position

Part/Full Time

From To

Supervisor

________________________________________________________________________________________

High

School

College

University

Undergraduate,

Graduate

and

Summer

School

IV.

REFERENCES

(Within the last 5 years)

_________________________________________________________________________________________

Name

Position or Type of work

Address & Phone No. if available

_________________________________________________________________________________________

CANDIDATE'S STATEMENTS

(Respond in your own handwriting)

Describe your philosophy of education, accomplishments, skills or expertise which qualifies you for

this position.

__________________________________________________________________________________

Why have you chosen the Williamson Central School system as the place you wish to teach?

__________________________________________________________________________________

What recent development in education seems to be most exciting and promising to you? Why?

__________________________________________________________________________________

Please give any other further information you may desire to offer which will assist us to properly

evaluate your promise as a teacher in the Williamson Central Schools.

VI.

INTERESTS AND ACTIVITIES

List any sport and level you would be willing to coach: _____________________________________________

________________________________________________________________________________________

Do you hold a coaching certificate? ___________________________________________________________

List any school activities you would be interested in advising or coadvising: ___________________________

________________________________________________________________________________________

PLEASE INCLUDE THE FOLLOWING WITH THE APPLICATION:

A copy of your Resume

A copy of your New York State Certification for the position you are applying for (i.e. Certificate

of Qualification and/or Provisional Certificate and/or Permanent Certificate)

A copy of Placement Folder (forwarded by college)

_________________________________________________

Signature