Have you ever wondered what it would be like to be a teacher in Oregon? Wonder no more! The Oregon Teacher Application Form is now available online. This form can help potential teachers learn about the necessary qualifications, application process, and certification requirements needed to teach in Oregon schools.
We've collected some technical information regarding the oregon teacher application. It is suggested that you look at this material before you start filling out the PDF.
Question | Answer |
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Form Name | Oregon Teacher Application |
Form Length | 6 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 1 min 30 sec |
Other names | oregon statewide teacher application, statewide application, oregon statewide teacher inservice day, oregon statewide application |
O REGO N
STATEWIDE TEACHER APPLICATIO N
Produced by O regon School Personnel Association • 1994
O FFICE USE O NLY
Date Received
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(Note: Individual school districts may require additional information other than that asked for on this application.)
PERSO NAL INFO RMATIO N
Application Date: _______________________________________ Social Security Number ____________________________________________
Full Name ___________________________________________________________ |
Date of Availability ______________________________ |
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Last |
First |
Middle |
Month |
Day |
Year |
Previous or other surname(s) reflected on employment or educational records ______________________________________________________
Previous Mailing Address ________________________________________________________ |
Phone (________)_____________________ |
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❏ phone number is unlisted |
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Msg. Phone (________)________________ |
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City |
State |
Zip Code |
Where you can always be reached |
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❏ phone number is unlisted |
Permanent Mailing Address ______________________________________________________ |
Phone (________)_____________________ |
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❏ phone number is unlisted |
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City |
State |
Zip Code |
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Name of contact if other than applicant ______________________________________________________________________________________
Currently under contrac t with another school distric t? |
❏ Yes |
❏ No |
If yes: School District ___________________________________________________ |
City _________________________________________ |
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Current O regon Teaching License
Type(s) (e.g. Basic
Endorsement(s) (e.g. Physical Education) ____________________________________________________________________________
Authorization(s) (e.g. 018) ________________________________________________________________________________________
Date of Expiration _______________________________________________________________________________________________
Added endorsements expected ____________________________________________________________________________________
If no O regon License, when is it expected? _______________________________
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❏ Temporary Contract |
❏ Substituting |
❏ O ther _____________________________________ |
Personal History
Have you ever:
YES N O
❏❏ • been dismissed from a teaching position?
❏❏ • been asked to resign from a teaching position?
❏❏ • been refused continuing employment as a teacher?
❏❏ • 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
If yes, please explain. _____________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
PO SITIO N PREFERENCE(S)
Denote any lice nse d area for which you are applying. List your preference by indicating “1” as your first choice .
Failure to prioritize could adversely affec t your chances of being considered.
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SPECIALIST |
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Indicate your grade preference, with 1 being your first choice . |
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_____ Preschool |
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Check any area(s) for which you are applying |
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❏ Band |
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❏ O rchestra |
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❏ Staff Development |
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❏ Computer Science |
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❏ PE |
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❏ TAG |
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❏ General Music |
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❏ PT/ O T |
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❏ Testing/ Assessment |
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❏ Librarian/ Media Specialist |
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❏ Reading |
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❏ O ther _________________________________ |
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SPECIAL SERVICES |
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Indicate your grade preference, with 1 being your first choice . |
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_____ Preschool |
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Check the box(es) for the area(s) you are licensed to teach and are applying: |
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❏ Adaptive PE |
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❏ Nurse |
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❏ Bilingual/ ESL/ Multicultural |
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❏ O ccupational Therapy |
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❏ Chapter I |
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❏ O ther Health Impaired |
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❏ Counselor/ Child Development Specialist |
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❏ Psychologist |
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❏ Developmentally Disabled |
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❏ Physical Therapy |
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❏ Drug/ Alcohol Specialist |
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❏ Sensory Impaired |
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❏ Handicapped Learner |
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❏ Severely Emotionally Disturbed |
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❏ Hearing Impaired |
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❏ Social Worker |
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❏ Home Teaching/ Tutoring |
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❏ Speech/ Language |
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❏ Learning Disabled |
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❏ Structured Learning Center |
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❏ Mildly Mentally Retarded |
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❏ Visually Impaired |
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❏ Moderately to Severely Mentally Retarded |
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❏ Word Experience |
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❏ O ther __________________________________ |
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ELEMENTARY |
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Indicate your grade preference, with 1 being your first choice . |
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_____ Early Childhood Ed./ Kindergarten |
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_____ Middle School (with elementary certificate) |
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_____ Primary (grades |
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_____ Blended or |
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_____ Intermediate (grades |
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_____ O ther (see Specialists) |
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* Grade 6 is in the elementary school in some districts, and in the middle school in others. |
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SPECIALIST |
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Indicate your grade preference, with 1 being your first choice . |
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_____ 6th (middle school) |
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_____ Alternative School |
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Check the area(s) for which you are applying and hold endorsement(s) |
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❏ Agricultural Sci. Tech. |
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❏ Health |
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❏ Mathematics |
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❏ Art |
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❏ Home Economics |
❏ Basic Math |
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❏ Business Education |
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❏ Industrial Arts/ Trades/ |
❏ Advanced Math |
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❏ Career Education |
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Technology Ed/ Vocational Ed |
❏ Music |
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❏ Computer Science |
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❏ Agriculture |
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❏ Band |
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❏ Dance |
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❏ Auto |
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❏ O rchestra |
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❏ Drama |
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❏ Construction |
❏ Vocal |
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❏ Driver’s Education |
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❏ Drafting |
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❏ O ther ___________________ |
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❏ English/ Language Arts |
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❏ Graphics |
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❏ Physical Education |
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❏ Foreign Language |
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❏ Metals |
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❏ Science |
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❏ French |
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❏ Technology Ed |
❏ Biology |
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❏ German |
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Specify _________________ |
❏ Chemistry |
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❏ Japanese |
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❏ Woods |
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❏ Integrated Sciences |
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❏ Latin |
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❏ Work Experience Cood. |
❏ Physics |
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❏ Russian |
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❏ O ther __________________ |
❏ Social Studies |
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❏ Spanish |
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❏ Speech |
❏ O ther ________________ |
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❏ O ther (see Specialists) |
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EDUCATIO NAL/ WO RK EXPERIENCE
EDUCATIO NAL AND PRO FESSIO NAL BACKGRO UND
High School, Colleges, Universities |
Dates Attended |
Type of Degree |
Major & |
Name, City, State |
Mo/ Yr to Mo/ Yr |
Earned |
Minor (if any) |
High School
College/ University
TEACHING EXPERIENCE
Include only those positions for which a teaching license was required (list most recent first). Approval of experience shall be determined at the time of employment. You will be asked to provide official verification.
Distric t Name |
Name |
Grade |
Subjec t(s) |
Dates of |
Total |
Reason |
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Address (Street, City, State) |
of School |
Taught |
Taught |
Employment |
Years |
for Leaving |
STUDENT TEACHING EXPERIENCE
Please list experiences in a recognized teacher preparation program only. |
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Distric t Name & School |
Grade(s) |
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Address (Street, City, State) |
Taught |
Subjec t(s) Taught |
Dates Taught |
Supervising Teacher |
EXPERIENCE O THER THAN TEACHING
Do not list military experience here .
Employer |
Address |
Position |
Dates of Employment |
REFERENCES
Give references (a minimum of three), especially superintendents or principals under whom you have taught, who have
Name |
Position/ District |
Address |
Work Phone Home Phone |
TRAINING AND PREPARATIO N
SPECIAL TRAINING
Please use key to indicate experience or training in any of the following specific classes or workshops.
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KEY: T = Training |
E = Experience |
T/ E = Both |
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_____ Authentic Assessment |
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_____ Equity Awareness |
_____ Portfolios |
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_____ Child Abuse/ Personal Safety |
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_____ Gifted Education |
_____ Remedial Education |
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_____ Computer Training |
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_____ Inclusive Education |
_____ Signing |
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_____ Cooperative Learning |
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_____ Integrated Curriculum |
_____ Study Skills |
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_____ Conduct Disorders |
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_____ ITIP |
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_____ Task Writing/ Rubrics |
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_____ Critical Thinking Skills |
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_____ Learning Skills |
_____ Visual/ Manipulative Math |
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_____ Current First Aid Card |
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_____ Middle Level Education |
_____ Whole Language |
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_____ Curriculum Integration |
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_____ O ther _________________ |
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_____ Developmentally Appropriate Practices |
_____ Multicultural Awareness |
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_____ Drug/ Alcohol Problems |
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_____ Peer Coaching |
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EXPERIENCE O THER THAN TEACHING
OTHER LANGUAGES: Please list any foreign language(s) you can use. ____________________________________________________________
❏Fluent skills (speak, read, write)
❏Minimal skills (please list abilities) ________________________________________________________________________________
_________________________________________________________________________________________________________
Actual language training ________________________________________________________________________________________
ELEMENTARY APPLICANTS: Check areas in which you have training or experience to the extent the skill(s) could be used in class. ❏ Play Piano ❏ Teach PE ❏ Teach Art ❏ Teach Vocal Music
PLACEMENT FILE
Do you have current placement file(s)? |
❏ Yes ❏ No |
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I requested a copy of my placement file to be sent to the appropriate school district. |
❏ Yes |
❏ No |
MILITARY EXPERIENCE
Branch of Service |
Job Classification |
Inclusive Dates |
Type of Discharge |
Citizenship: Are you a U.S. citizen or otherwise legally authorized to work in the U.S.? ❏ Yes ❏ No
Health: Is your physical/ mental health condition such that you can fulfill the essential job functions of the teaching/ extracurricular work for
which you are applying (either with or without reasonable accommodations)? |
❏ Yes ❏ No |
APPLICATIO N S
Applications which are forwarded to a school district will remain active at that district for one year. The district will normally keep the application on file for three years. Contact individual districts about procedures for reactivating an application that is more than one year old.
I understand that any omissions on this application may prevent my application from being evaluated or referred to an individual school district. I authorize any school district to which this application is submitted to obtain information about my criminal records. I authorize all governmental agencies to provide information about my criminal records to the school district. I verify that all information on this employment application is true and complete . I understand that any misrepresentation, falsification, or omission on this application or on other documents submitted to the school district will be sufficient cause for this application not to be considered by the school district, not to be referred to a school district, or for discharge if I have been employed.
AUTHO RIZATIO N TO O BTAIN AND RELEASE INFO RMATIO N
I authorize any O regon school district for which I have completed an employment application to check my references, to obtain information from my prior employers and educational institutions, and to take other actions to investigate any information provided in my employment application, and to obtain information relevant to evaluating my qualifications and fitness for a teaching position. I authorize my listed references, past employers and educational institutions, and anyone else who has information about my work history, education qualification or fitness, to provide such information to any school district for which I have completed an employment application. I release the school district and all persons providing information to the school district from any liability whatsoever for obtaining and providing that information, regardless of the results.
Signature ______________________________________________________________________________ Date _____________________________________
O REGO N
STATEWIDE TEACHER APPLICATIO N
AN EQ UAL O PPO RTUNITY EMPLOYER
EQ UAL O PPO RTUNITY INFO RMATIO N
O regon school distric ts are equal opportunity employers and comply with all applicable state and federal statutes and regulations in employment and school distric t programs.
O regon school districts are committed to maintaining
______________________________________________________________________________________________________________________
Name
______________________________________________________________________________________________________________________
Position for which you are applying
If you prefer not to provide the information requested below, please sign and date .
_____________________________________________________________________ |
_____________________________________________ |
Signature |
Date |
VO LUNTARY INFO RMATIO N
This information is voluntary and is collec ted for Equal Employment O pportunity reporting purposes. This form will be physically separated from your other application materials and will not affec t the application process in any manner. Should you prefer not to provide this information, there will be no effec t on your application.
Sex
❏Female
❏Male
Date of Birth ______/ ______/ ______
Race or Cultural Group (Check one only)
❏American Indian/ Alaskan Native
❏Asian/ Pacific Islander
❏White
❏Black
❏Hispanic
❏O ther ____________________________________
W hen this page is forw arded to an individual school district, the receiving district w ill rem ove this page so as to allow the collection of data.
COACHING & ADVISING
Extra/ Co
Check those you are capable of and willing to supervise (e .g. V = Varsity, JV = Junior Varsity, F = Freshman). For
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POSITIONS QUALIFIED TO CONDUCT |
COACHING/ ADVISORY EXPERIENCE |
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HEAD |
ASST. |
V |
JV |
F |
ELEM |
MS |
HS |
CO LL |
Activities Coordinator |
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Athletic Director |
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Athletic Trainer |
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Baseball |
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Basketball |
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Chess |
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Computer Club |
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Cross Country |
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Dance |
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Debate Team |
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Drama |
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Driver’s Education |
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Football |
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Golf |
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Gymnastics |
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Hockey |
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Honor Society |
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Intramurals |
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Language Clubs |
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Literary Magazine |
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Mock Trial |
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Newspaper |
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O utdoor Education |
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P.E. Club |
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Rifle/ Shooting |
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Science Club |
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Student Council |
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Track |
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Vocal Music |
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Water Polo |
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Weight Lifting |
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Wrestling |
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