OREGON |
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OFFICE USE ONLY |
STATEWIDE TEACHER APPLICATION |
Dated Received |
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Produced by Oregon School Personal Association 1994 |
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(Note: Individual school districts may require additional information other than that asked for on this application.)
PERSONAL INFORMATION
Application Date: __________________________________ Social Security Number __________--________--_________
Full Name ______________________________________________________ Date of Availability _____________________
LastFirstMiddleMonth Day Year
Previous or other surname(s) reflected on employment or educational records ___________________________________
Present Mailing Address ________________________________________________ Phone (____)_____________________
StreetPhone number is unlisted
______________________________________________________________________ Msg. Phone (_____)_______________
City |
State |
Zip Code |
Where you can always be reached |
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Phone number is unlisted |
Permanent Mailing Address _____________________________________________ Phone (_____)____________________
Street |
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Phone number is unlisted |
_______________________________________________________________________ |
City |
State |
Zip Code |
Name of contact if other than applicant ______________________________________________________________________
Currently under contract with another school district? YesNo
If Yes: School District _________________________________________________ City ___________________________________________
Current Oregon Teaching License
Type(s) (e.g. Basic D- 474, Temporary, ect.) ___________________________________________________________________________________________
Endorsements(s) (e.g. Physical Education) ____________________________________________________________________________________________
Authorization(s) (e.g. 018) _________________________________________________________________________________________________________
Date of Expiration ________________________________________________________________________________________________________________
Added endorsements expected ______________________________________________________________________________________________________
If no Oregon License, when is it expected? ____________________________________
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Month |
Year |
Full-Time Contract |
Part-Time Contract |
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Temporary Contract |
Substituting |
Other _______________________________________________ |
Personal History
Have you ever
Yes No
•been dismissed from a teaching position?
•Had a teaching license revoked?
•Been convicted, pled guilty or pled nolo contendere to a felony?
•Been convicted, pled guilty, or pled nolo contendere to a crime involving child abuse or sexual abuse?
•Had a report of child abuse or sexual activities involving a K-12 student or minor filed against you with a school district,
Children Services Division, a police agency, or in court?
If yes, please explain. _________________________________________________________________________________________________
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