PDE 353A: Pennsylvania Standard Application For Teaching Position

Under Contact Information, enter Position(s) Desired, Last Name, First Name, Middle Name and Professional Personnel ID.

Under Present Address, enter Street Address, City, State, Zip Code and Phone.

Under Permanent Address, enter Street Address, City, State, Zip Code, Phone and E-Mail Address.

List, in order of preference, the grades, subjects, and/or positions for which you are applying: 1. 2. 3.

Under 3. Certification, list all areas in which you hold valid Pennsylvania and/or out-of-state teaching certificates: Area of Certification, Issuing State and Date Issued.

Applicants holding a certificate from another state must obtain a Pennsylvania Certificate in order to teach in Pennsylvania Public Schools.

Have you acquired tenure in Pennsylvania? Yes or No. If yes, enter in what school district, and enter the Date available for employment.

If you are not employed full-time, are you interested in being placed on the substitute list? Yes or No. Then Yes or No for Long-term Substitute and for Short-term Substitute.

Under Educational Background, for each Grade Level (High School, College/University, College/University, Graduate Study, Graduate Study) enter School or Institution and Location, Major/Minor, Diplomas, Degrees or Credits Earned and Grade Point Average (GPA).

Under Experience (Present or most recent first), list Position 1, Position 2 and Position 3.

For each position, enter Name of Employer, Address, Date Started, Date Ended, Your Title, Work Phone, Work Performed, Reason for Leaving, Name and Title of Supervisor and Final Yearly Salary.

Under Qualifications, list activities that you are qualified to supervise or coach.

Under Student or Practice Teaching, if you have not been previously employed in a teaching position, enter Grade or Subject Taught, Name and Address of School and College Supervisor and Cooperating Teacher.

Student Teaching References: please attach photocopies of letters of reference and/or evaluations from college/university student teacher supervisor and cooperating teacher(s).

References should include superintendents, principals or professors who have first-hand knowledge of your professional competence and your personal qualifications: enter Name, Position, Address and Phone.

Experienced teachers should include the superintendent and principal of the two most recent schools in which employed.

If any person(s) listed should not be contacted for reference at present time, indicate the date contact(s) may be made.

Other Qualifications: summarize special job-related skills and qualifications acquired from employment or other experiences (including U.S. military service) and/or state any additional information that may be helpful in considering your application, i.e. honors, awards, activities, technology skills or professional development activities.

You must give complete answers to all questions. If you answer “Yes” to any question, you must list all offenses, and for each conviction provide the date of conviction and disposition, regardless of the date or location of occurrence.

Answer Yes or No to each Question: Were you ever convicted of a criminal offense? Are you currently under charges for a criminal offense? Have you ever forfeited bond or other collateral in connection with a criminal offense? Within the last ten years, have you been fired from any job for any reason? Within the last ten years, have you quit a job after being notified that you would be fired?

Have you ever been professionally disciplined in any state? Professionally disciplined means the annulment, revocation or suspension of your teaching certification or having received a letter of reprimand from an agency, board or commission of state government, such as the Pennsylvania Professional Standards and Practices Commission? Yes or No.

Are you subject to any visa or immigration status, which would prevent lawful employment? Yes or No.

You may omit: minor traffic violations, offenses committed before your 18th birthday which were adjudicated in a juvenile court or under a Youth Offender Law, and any convictions which have been expunged by a court or for which you successfully completed an Accelerated Rehabilitative Disposition program.

Criminal offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of “nolo contendere” (no contest). Conviction is an adjudication of guilt before a court and includes determinations before a court, a district court justice or a magistrate, which results in a fine, sentence or probation.

If you answered “Yes” to any of the questions in General Background Information, please provide a detailed explanation on a separate sheet of paper, including dates, and attach it to this application. Please print and sign your name on the sheet and include your social security number.

Your answers will be verified with appropriate police records.

ACT 34 Clearance (PA State Police Criminal Background Check): each applicant must submit with his/her employment application a copy of a Criminal History Record from the Pennsylvania State Police, an ORIGINAL report, which may not be more than one (1) year old.

ACT 114 (Federal Criminal History Record): each applicant must submit with his/her employment application a copy of a Federal Criminal Record from the Federal Bureau of Investigation (FBI), an ORIGINAL report, which may not be more than one (1) year old.

ACT 151 Clearance (PA Child Abuse History Clearance): each candidate must submit with his/her employment application a copy of an official clearance from the Pennsylvania Department of Public Welfare, an ORIGINAL report, which may not be more than one (1) year old.

Please write an essay as described on page seven. For your convenience, you may attach a sheet; however, your essay may not exceed one page. At the bottom of the attachment, please print and sign your name.

Please select one of the following topics and write an essay in the space provided on the Essay page.

1. The Most Important Qualities of an Outstanding Educator. 2. My Philosophy of Student Discipline. 3. The Importance of Continuing Professional Development and How I Plan to Incorporate It Throughout My Career. 4. Essential Elements of Instruction, Administration, or Area of Certification. 5. How Information Technology (i.e. computers, Internet) Can Be Integrated into the Instructional Process and Curriculum.

SIGN: Signature Printed Name.

Certification and Release Authorization: I certify that all of the statements made by me are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I further certify that I am the sole author of the essay.

I understand that any misrepresentation of information shall be sufficient cause for: (1) rejecting my candidacy, (2) withdrawing of any offer of employment, or (3) terminating my employment.

I hereby authorize any and all of my previous employers and/or supervisors to release any and all of my personnel records, and to respond fully and completely to all questions that the officials of (school districts) may ask regarding my prior work history and performance.

However, I do not authorize the production of medical records or other information, which would tend to actually identify a disability nor do I authorize inquiries which would include any information related to any medical condition or medical history.