Baker Schools 5J Certified App

Baker Schools 5J

Certified Employment Application

Applicant Information
Position For Which You Are Applying *
Application Date *

Month Day Year
Date
Social Security Number *
Applicant Name *

First Name Middle Name Last Name
Date of Availability

Month Day Year
Date
Previous or Other Surname(s) Reflected on Employment or Educational Records

Surname Maiden Name
Present Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Permanent Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of Contact if Other than Applicant for Permanent Mailing Address
Primary Phone Number *

Area Code Phone Number
Message Phone Number

Area Code Phone Number
Email *
example@example.com
Are you Currently Under Contract With Another School District? *
If Yes
School District & City
Current Oregon Teaching License (e.g Basic D-474, Initial, Temporary, etc.) *
Endorsements (e.g. Physical Education, Reading, ESL, etc)
Authorizations (e.g. 018; ML/HS, etc)
Date of Expiration

Month Day Year
Date
Added Endorsements Expected
If no Oregon License, When is it Expected?

Month Day Year
Date
Position Preference *

Full-Time Contract Temporary Contract Part-Time Contract

Personal History
Personal History
Have you Ever Been.... (Yes/No)
Dismissed From a Teaching Position/Asked to Resign From a Teaching Position? *
Refused Continuing Employment as a Teacher/ Had a Teaching License Revoked? *
Convicted of, Pled Guilty, or no Contest to a Felony? *
Convicted of, Pled Guilty, or no Contest to a Crime Involving Child Abuse/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, Child Services Division, Police Agency, or in Court? *
If Yes, Please Explain:

Educational and Professional Background
Educational and Professional Background
High School *
Date Attended *

Month Day Year
Date
To *

Month Day Year
Date
Type of Degree Earned *
College/University *
Date Attended *

Month Day Year
Date
To *

Month Day Year
Date
Type of Degree Earned *
Major/Minor *
College/University
Date Attended

Month Day Year
Date
To

Month Day Year
Date
Type of Degree Earned
Major/Minor
College/University
Date Attended

Month Day Year
Date
To

Month Day Year
Date
Type of Degree Earned
Major/Minor
College/University
Date Attended

Month Day Year
Date
To

Month Day Year
Date
Type of Degree Earned
Major/Minor

Student Teaching Experience
Student Teaching Experience
Please list experiences in a recognized teacher preparation program only.
District Name & School, Address (Street, City, State)
Grade(s) Taught
Subject(s) Taught
Dates Taught
Supervising Teacher

First Name Last Name
Email
example@example.com
District Name & School, Address (Street, City, State)
Grade(s) Taught
Subject(s) Taught
Dates Taught
Supervising Teacher

First Name Last Name
Email
example@example.com

Teaching Experience
District Name
Name of Supervisor

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of School
Grade(s) Taught
Subject(s) Taught
Full-Time/Part-Time
Dates of Employment
Please Enter Beginning Date and Ending date IE. 1/2/2013 to 6/3/2016
Total Years Employed by This School District
Reason For Leaving
District Name
Name of Supervisor

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of School
Grade(s) Taught
Subject(s) Taught
Full-Time/Part-Time
Dates of Employment
Please Enter Beginning Date and Ending date IE. 1/2/2013 to 6/3/2016
Total Years Employed by This School District
Reason For Leaving
District Name
Name of Supervisor

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of School
Grade(s) Taught
Subject(s) Taught
Full-Time/Part-Time
Dates of Employment
Please Enter Beginning Date and Ending date IE. 1/2/2013 to 6/3/2016
Total Years Employed by This School District
Reason For Leaving
District Name
Name of Supervisor

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of School
Grade(s) Taught
Subject(s) Taught
Full-Time/Part-Time
Dates of Employment
Please Enter Beginning Date and Ending date IE. 1/2/2013 to 6/3/2016
Total Years Employed by This School District
Reason For Leaving
District Name
Name of Supervisor

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of School
Grade(s) Taught
Subject(s) Taught
Full-Time/Part-Time
Dates of Employment
Please Enter Beginning Date and Ending date IE. 1/2/2013 to 6/3/2016
Total Years Employed by This School District
Reason For Leaving

Employment Other Than Teaching
Employment Other Than Teaching
Do Not List Milliray Experiece Here
Employer
Address
Name of Supervisor

First Name Last Name
Email
example@example.com
Work Phone Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
Position
Dates Employed
Employer
Address
Name of Supervisor

First Name Last Name
Email
example@example.com
Work Phone Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
Position
Dates Employed
Employer
Address
Name of Supervisor

First Name Last Name
Email
example@example.com
Work Phone Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
Position
Dates Employed
Employer
Address
Name of Supervisor

First Name Last Name
Email
example@example.com
Work Phone Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
Position
Dates Employed

References
References
Give references (a minimum of three), especially superintendents, or principals under whom you have taught, who have first-hand knowledge of your character, personality and teaching ability.
Name *

First Name Last Name
Type Reference *
Email *
example@example.com
Address *
Position/District *
Work Phone Number *

Area Code Phone Number
Home Phone Number *

Area Code Phone Number
Name *

First Name Last Name
Type Reference *
Email *
example@example.com
Address *
Position/District *
Work Phone Number *

Area Code Phone Number
Home Phone Number *

Area Code Phone Number
Name *

First Name Last Name
Type Reference *
Email *
example@example.com
Address *
Position/District *
Work Phone Number *

Area Code Phone Number
Home Phone Number *

Area Code Phone Number
Name

First Name Last Name
Type Reference
Email
example@example.com
Address
Position/District
Work Phone Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number

Special Education
Special Education
Denote any licensed area for which you are applying. List your preference by indicating “1” as your first choice.

Failure to prioritize could adversely affect your chances of being considered.
K-5th Grades
6th-8th Grades
9th-12th Grades
Check the box(es) for the area(s) you are licensed to teach and are applying:
Special Education: Generalist Special Education: Deaf and Hard of Hearing Special Education: Visually Impaired

Elementary
Elementary
Denote any licensed area for which you are applying. List your preference by indicating “1” as your first choice.

Failure to prioritize could adversely affect your chances of being considered.
Early Childhood Ed./Kindergarten
Primary Grades 1-3
Intermediate(grade 4-6*)
Middle School (with elementary certificate)
Blended or Multi-Age Classrooms
Other (see Specialists)

Special Training
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
Child Abuse/Personal Safety
Computer Training
Cooperative Learning
Conduct Disorders
Critical Thinking Skills
Developmentally Appropriate Practices
Drug/Alcohol Problems
Equity Awareness
Gifted Education
Inclusive Education
Integrated Curriculum
ITIP
Learning Styles
Middle Level Education
Multi-Age Class
Multi-Cultural Awareness
Peer Coaching
Portfolios
Remedial Education
Signing
Study Skills
Task Writing/Rubrics
Visual/Manipulative Math
Whole Language
Trauma Informed Practices
Other

Experience Other Than Teaching
Educational Experience Other Than Teaching
OTHER LANGUAGES: Please list any foreign language(s) you can use. Fluent skills (speak, read, write)
Please List Abilities Here
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.

Teach Piano Teach Art Teach PE Teach Vocal Music

Placement File
Placement File
Do you have a current placement file(s)? *
I requested a copy of my placement file to be sent to the appropriate school district

Veterans Preference
Military Experience
Are you a "Veteran" as defined under Oregon law (ORS 408.225(f))?
Are you a "Disabled Veteran" as define under Oregon law (ORS 408.225(c))?
If Yes to either of the two above questions please upload a copy of the Certificate or Discharge from Active Duty (DD Form 214 or 215), PDF format preferred

Browse Files
PDF File Format Cancel of
If Yes to being a "Disabled Veteran" please upload a copy the Veterans Disability Preference Letter, PDF format preferred

Browse Files
PDF File Format Cancel of
Citizenship: Are you a U.S. citizen or otherwise legally authorized to work in the U.S.? *
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)? *

File Uploads
Resume/Cover Letter and Letters of Recomendation Upload
Resume File Upload (PDF) *
PDF File Format Click to select and upload file
Cover Letter (PDF) *
PDF File Format Click to select and upload file
Copy of Letter of Recommendation #1 *
PDF File Format Click to select and upload file
Copy of Letter of Recommendation #2 *
PDF File Format Click to select and upload file
Copy of Letter of Recommendation #3 *
PDF File Format Click to select and upload file
Copy of your Degree
PDF File Format Click to select and upload file
Copy of your Degree (Graduate)
PDF File Format Click to select and upload file
Copy of Your Degree (Post-Graduate)
Click toPDF File Format Click to select and upload file
Copy of Your Current Teaching License (PDF)
Click to select and upload file (if you do not have your license yet, scan a piece of paper into a pdf indicating so)

Application Signature
APPLICATIONS

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.

AUTHORIZATION TO OBTAIN AND RELEASE INFORMATION
I authorize any Oregon 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 qualification 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. *By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally
*By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally
Today's Date *

Month Day Year
Date
*Note You must click the submit button at the bottom of this application in order for it to be completed. If you don't click this button, your information will not be sent to us.

Criminal History Check/Fingerprinting Consent
I understand that law and Baker School District 5J Board Policy require criminal history records check and fingerprinting. Employment shall be offered prior to fingerprint collection. Upon receipt of notification by the Oregon Department of Education that I have been convicted or made a false statement as to conviction of any crimes prohibiting employment or contract status with Baker School District 5J, the Superintendent or his/her designee shall immediately terminate my employment or contract. I understand that if I am terminated I may appeal action taken by the Oregon Department of Education as result of such check in accordance with procedures established by law. Should I refuse to consent to a criminal history records check, or refuse to fingerprinted, I shall immediately be terminated from employment or contract status by the Superintendent or his/her designee. *By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally
*By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally
Today's Date *

Month Day Year
Date

Equal Opportunity Employer/Drug Free Workplace
AN EQUAL OPPORTUNITY EMPLOYER & Drug-free Workplace
Baker School District is an equal opportunity educator and employer and does not discriminate on the grounds of race, color, religion, sex, sexual orientation, national origin, marital status, age, veterans’ status, genetic information, disability, culture and/or financial status. Baker School District is Drug-free Workplace. Oregon school districts are committed to maintaining drug-free workplaces and comply strictly with all applicable state and federal statutes and regulations in employment and school district programs. *By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally *
*By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally
Position for which you are applying for: *
Date

Month Day Year
Date

Voluntary Information
Voluntary Information
If you prefer not to provide the information requested below, please sign and date.
Digital Signature * (only sign if you wish to not provide information in this section of the application). *By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally
*By typing in your full first, middle initial, and last name you are agreeing to signing this document digitally
Today's Date

Month Day Year
Date
This information is voluntary and is collected only for Equal Employment Opportunity reporting purposes. The information will not affect the application process in any manner. Should you prefer not to provide this information, there will be no effect on your application.
Sex
Date of Birth

Month Day Year
Date
Race or Cultural Group (Check one only)

Hispanic Option 2 Native American/Alaska Native White/Caucassian Asian/Pacific Islander

Submission
If you have completed the form entirely, please use the "Submit" button. If you need to come back to this application later and are not ready to submit it to our HR department yet, please select the "Save" button and follow the instructions.
I am not a robot *
Should be Empty: