Woodlawn School District

6760 Hwy. 63

Rison, AR 71665

Phone (870)357-8108   Fax (870)357-8718

Instructional and Administrative Application

Name:_____________________________________________  Date:_____________________________

Position Desired:_______________________________________________________________________

(Indicate levels in elementary school or subjects in middle, junior or senior high school in order of preference.)

Date Available:________________________________

Social Security Number:_________________________

Applicants for employment are accepted without regard to sex, race, color, national origin, physical/mental handicap, age, religion, or political affiliation.  Conviction of a crime does not automatically bar any applicant from employment with our school.

Woodlawn School Certified Application

Name:___________________________________________________________________________

Present Address:___________________________________________________________________

Home Phone:________________ Cell Phone:________________________Birthdate:____________

In Case of Emergency Notify:_____________________________________ Relation:_____________

Phone:__________________

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Are you a U.S. Citizen?___________                        If not, are you a Legal Alien?____________________

Have you ever been convicted of a crime/felony?_______________    

If yes, please explain:____________________________________________________________________

Are you currently listed on the child maltreatment registry?______________________

You are required to have a criminal background check by the Arkansas Department of Education.  Forms are available in the superintendent’s office.

References: Please list four references; include superintendents and principals under whom you have worked.

Educational and Professional Training:

Total Semester Hours or Credits:                                                                                                     __ ________

Undergraduate                                                                             Major:_________________________________

Area of Specialization                                                                  Minor:_________________________________

Graduate                                                                                        Major:_________________________________

Area of Specialization                                                                  Minor:_________________________________

College activities in which you have participated:_____________________________________________

Practice Teaching

Name of School:________________________________________________________ Date:___________

Grade or subject taught:_________________________________________________________________

Principal:_________________________________ Supervising Teacher:___________________________

Do you hold an Arkansas Teaching Certificate?_________ Expiration Date:_________________________

Type:                    Regular                                                                            Provisional

Elementary _________________________                                          ________________________________

Secondary  _________________________                                           ________________________________

Subjects qualified to teach as listed on Teaching License: ______________________________________

Teaching Experience:  List all experience in chronological order:

Total Years of Experience:__________________

List annual salary of last teaching position held:  $_______________________________

Activities you would be willing to sponsor:______________________________________________________

I authorize investigation of all statements contained in this application.  I understand misrepresentation or omission of facts is cause for dismissal without notice at any time during my employment.

I agree, if employed, to follow all rules and regulations of the district.

I understand, by state law, the board of education must require all employees to submit a health certificate from a physician along with a  tuberculin test, at my expense.

I agree to promptly notify the district of any change of address during my employment.

Signature:____________________________________                                    Date:_____________________