Oregon Teacher Application PDF Details

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.

QuestionAnswer
Form NameOregon Teacher Application
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesoregon statewide teacher application, statewide application, oregon statewide teacher inservice day, oregon statewide application

Form Preview Example

O REGO N

STATEWIDE TEACHER APPLICATIO N

Produced by O regon School Personnel Association • 1994

O FFICE USE O NLY

Date Received

_________________

(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 ______________________________

Last

First

Middle

Month

Day

Year

Previous or other surname(s) reflected on employment or educational records ______________________________________________________

Previous Mailing Address ________________________________________________________

Phone (________)_____________________

 

Street

 

phone number is unlisted

______________________________________________________________________________

Msg. Phone (________)________________

City

State

Zip Code

Where you can always be reached

 

 

 

phone number is unlisted

Permanent Mailing Address ______________________________________________________

Phone (________)_____________________

 

Street

 

phone number is unlisted

______________________________________________________________________________

 

City

State

Zip Code

 

Name of contact if other than applicant ______________________________________________________________________________________

Currently under contrac t with another school distric t?

Yes

No

If yes: School District ___________________________________________________

City _________________________________________

 

 

 

Current O regon Teaching License

Type(s) (e.g. Basic D-474, Temporary, etc.) ___________________________________________________________________________

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? _______________________________

 

Month

Year

Full-Time Contract

Part-Tine Contract

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 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. _____________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

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.

 

 

 

 

 

SPECIALIST

 

Indicate your grade preference, with 1 being your first choice .

 

 

_____ Preschool

_____ K-5

_____ 6-8

_____ 9-12

 

Check any area(s) for which you are applying

 

 

 

 

Band

 

 

O rchestra

 

Staff Development

Computer Science

 

 

PE

 

 

TAG

 

General Music

 

 

PT/ O T

 

Testing/ Assessment

Librarian/ Media Specialist

 

Reading

 

O ther _________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIAL SERVICES

 

Indicate your grade preference, with 1 being your first choice .

 

 

_____ Preschool

_____ K-5

_____ 6-8

_____ 9-12

 

Check the box(es) for the area(s) you are licensed to teach and are applying:

 

Adaptive PE

 

 

 

 

Nurse

 

 

Bilingual/ ESL/ Multicultural

 

 

 

O ccupational Therapy

 

Chapter I

 

 

 

 

O ther Health Impaired

 

Counselor/ Child Development Specialist

 

Psychologist

 

Developmentally Disabled

 

 

 

Physical Therapy

 

Drug/ Alcohol Specialist

 

 

 

Sensory Impaired

 

Handicapped Learner

 

 

 

Severely Emotionally Disturbed

 

Hearing Impaired

 

 

 

 

Social Worker

 

Home Teaching/ Tutoring

 

 

 

Speech/ Language

 

Learning Disabled

 

 

 

 

Structured Learning Center

 

Mildly Mentally Retarded

 

 

 

Visually Impaired

 

Moderately to Severely Mentally Retarded

 

Word Experience

 

Multi-Handicapped

 

 

 

 

O ther __________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ELEMENTARY

 

Indicate your grade preference, with 1 being your first choice .

 

 

_____ Early Childhood Ed./ Kindergarten

 

_____ Middle School (with elementary certificate)

_____ Primary (grades 1-3)

 

 

 

_____ Blended or Multi-Age Classrooms

_____ Intermediate (grades 4-6*)

 

 

_____ O ther (see Specialists)

 

* Grade 6 is in the elementary school in some districts, and in the middle school in others.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIALIST

 

Indicate your grade preference, with 1 being your first choice .

 

 

_____ 6th (middle school)

_____ 7-8

_____ 9-12

_____ Alternative School (6-12)

Check the area(s) for which you are applying and hold endorsement(s)

 

Agricultural Sci. Tech.

 

 

Health

 

Mathematics

Art

 

 

 

Home Economics

Basic Math

Business Education

 

 

 

Industrial Arts/ Trades/

Advanced Math

Career Education

 

 

 

Technology Ed/ Vocational Ed

Music

Computer Science

 

 

 

Agriculture

 

Band

Dance

 

 

 

Auto

 

O rchestra

Drama

 

 

 

Construction

Vocal

Driver’s Education

 

 

 

Drafting

 

O ther ___________________

English/ Language Arts

 

 

Graphics

 

Physical Education

Foreign Language

 

 

 

Metals

 

Science

French

 

 

 

Technology Ed

Biology

German

 

 

 

 

Specify _________________

Chemistry

Japanese

 

 

 

Woods

 

Integrated Sciences

Latin

 

 

 

Work Experience Cood.

Physics

Russian

 

 

 

O ther __________________

Social Studies

Spanish

 

 

 

 

 

 

Speech

O ther ________________

 

 

 

 

 

O ther (see Specialists)

 

 

 

 

 

 

 

 

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)

Full-Time or

Dates of

Total

Reason

Address (Street, City, State)

of School

Taught

Taught

Part-Time

Employment

Years

for Leaving

STUDENT TEACHING EXPERIENCE

Please list experiences in a recognized teacher preparation program only.

 

 

Distric t Name & School

Grade(s)

 

 

 

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 first-hand knowledge of your charac ter, personality, and teaching ability.

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.

 

KEY: T = Training

E = Experience

T/ E = Both

 

 

 

 

 

 

_____ Authentic Assessment

 

_____ Equity Awareness

_____ Portfolios

_____ Child Abuse/ Personal Safety

 

_____ Gifted Education

_____ Remedial Education

_____ Computer Training

 

_____ Inclusive Education

_____ Signing

_____ Cooperative Learning

 

_____ Integrated Curriculum

_____ Study Skills

_____ Conduct Disorders

 

_____ ITIP

 

_____ Task Writing/ Rubrics

_____ Critical Thinking Skills

 

_____ Learning Skills

_____ Visual/ Manipulative Math

_____ Current First Aid Card

 

_____ Middle Level Education

_____ Whole Language

_____ Curriculum Integration

 

_____ Multi-Age Class

_____ O ther _________________

_____ Developmentally Appropriate Practices

_____ Multicultural Awareness

 

_____ Drug/ Alcohol Problems

 

_____ Peer Coaching

 

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

 

 

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.

Drug-free Workplace

O regon school districts are committed to maintaining drug-free workplaces and comply with all applicable state and federal statutes and regulations in employment and school district programs.

______________________________________________________________________________________________________________________

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 -Curricular Ac tivities (Middle/ High Schools)

Check those you are capable of and willing to supervise (e .g. V = Varsity, JV = Junior Varsity, F = Freshman). For non-coaching ac tivities, check Head or Asst. only under “Positions Q ualified to Conduc t.”

 

POSITIONS QUALIFIED TO CONDUCT

COACHING/ ADVISORY EXPERIENCE

 

 

 

 

 

 

 

 

 

 

 

HEAD

ASST.

V

JV

F

ELEM

MS

HS

CO LL

Activities Coordinator

Annual

Athletic Director

Athletic Trainer

Band

Baseball

Basketball

Chess

Club Advisor

Computer Club

Cross Country

Dance

Debate Team

Drama

Driver’s Education

Football

Golf

Gymnastics

Hockey

Honor Society

Intramurals

Language Clubs

Literary Magazine

Mock Trial

Model U.N.

Musical

Newspaper

O rchestra

O utdoor Education

P.E. Club

Photography

Rally

Rifle/ Shooting

Science Club

Skiing

Soccer

Softball

Speech Team

Student Council

Swimming

Tennis

Track

Vocal Music

Volleyball

Water Polo

Weight Lifting

Wrestling

O ther _______________

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