GRUNDY COUNTY SCHOOLS

APPLICATION FOR PROFESSIONAL EMPLOYMENT

P.O. Box 97

1376 Main Street

Altamont, TN 37301

Phone: 931-692-3467

Fax: 931-692-2188

Web Address:  www.grundyschoolsystem.com

Grundy County School System supports affirmative action and does not discriminate against any applicant for employment based on race, color, sex, national origin, age, disability or veteran status.  If you are a person with a disability and require special accommodations to participate in the application or interview process, call 931-692-3467.

NAME____________________________________________________________

DATE_____________________________________

PRESENT ADDRESS________________________________________________

                                                             P.O.BOX                                                 STREET

_____________________________________________________________________________________

        City                                                                 State                                                          Zip

Telephone Number______________________ Social Security Number______________________

GRADE LEVEL OR SUBJECT AREA(S) FOR WHICH YOU ARE APPLYING:

First choice____________________________________________________________________

Second Choice_________________________________________________________________

STARTING DATE _____________________________________________________________

                                    Date you will be available to start work with the Grundy Schools

PRESENT POSITION_______________________AT__________________________________

                                         Subject or Guide                                           School and Location

Check type(s) of Tennessee License(s) now held:   OOSTT     Apprentice (AT)   Career Level I   

 (Include a photo copy)     Career Level II     Career Level III    Professional   Permanent   

Trade Stop    Occupational Education

License Number ______________License Issue Date _______________

License Expiration Date___________________

Subject licensed to teach__________________________________________________________

Areas of Cirtification____________________________________________________________

Highly Qualified?       Yes            No

If you do not have a Tennessee License, have you applied?   Yes   No If so, when did you apply?

_______________________

Are you eligible to work in the United States? _______________________________________________

EDUCATIONAL BACKGROUND: (in order, beginning with high school)

PREVIOUS EXPERIENCE: (Starting with your present position, list your professional teaching experience and any other work history, including service with the United States Armed Forces)

 STUDENT TEACHING (For applicants with 2 years or less teaching experience); Practicum; Internship; Special Programs Information:

Name of School______________________________________ School System ______________

Grade or Subjects_____________________________________ Dates_____________________

Name of Supervising Teacher(s):___________________________________________________

PROFESSIONAL REFERENCES:

1.      Are you registered with a university placement office? Yes   No   If yes, indicate the following:

Name of Office______________________________ Name of Institution__________________

Address_______________________________________________________________________

2.      List below people we may contact concerning you professional preparation and experience.  List only persons who know of your training, experience, or other qualifications for educational service.

Are you prepared to sponsor any activities that are extra-curricular?  Circle the items you would be willing to sponsor:

Cheerleaders         Basketball        Academic League      Yearbook     Other: ___________

If you are appointed to a position in the Grundy County Schools, you will be required to furnish the following information and materials:

1.      The Superintendent’s Copy of your current, valid Tennessee Teacher’s License(s).

2.      Verification of all prior teaching experience and active military service(Form DD 214)

3.      Official transcripts of all college or university courses

4.      You will be expected to have your finger prints prepared and be exposed to a drug test as well as have a physical examination by a doctor.

After one year, applications are discarded. If you want your application to remain in the active file, you must notify the Grundy County Board of Education in writing.

            The Grundy County School System is an Equal Employment Opportunity Employer

Grundy County School System does not discriminate on the basis of race sex, color, religion, national origin, age handicap, or veteran status in provision of educational opportunities or employment opportunities benefits.  The Grundy County School System does not discriminate in the basis of sex, or handicap in its educational programs and activities, pursuant to requirements of Section 504 of the Rehabilitation Act of 1973, Public Law 101-336, respectively.  This policy extends to both employment and enrollment in the school system.  Complaints of discrimination may be directed to the Grundy County Board of Education, P.O. Box 97, Altamont, Tennessee 37301, or phone 931-692-3467, Ext.7.

THE FOLLOWING INFORMATION IS REQUIRED BY LAW BY THE STATE OF TENNESSEE

*Be sure you underline the appropriate response in items 2 & 3 below.

1.      I recognize that, if I am employed, the board of education of the said school system will assign or reassign me to a specific position, as the need requires. 

2.      I hereby certify that I (have) (have not) been convicted of a misdemeanor or a felony in any state of the United States,  (*Knowledge falsifying information required by Sec. 49-5-406 (a)(1) shall be sufficient grounds for termination of employment and shall also constitute a Class A misdemeanor which must be reported to the District Attorney General for persecution.)

3.      * I further certify that I (have) (have not) been dismissed from any previous employment for improper or unprofessional conduct, inefficient service, neglect of duty, incompetence, or insubordination as the same are defined in Section 49-5-501 of the Tennessee Code.

If “have” is indicated, explain fully the details of each such dismissal in a separate sheet of paper.  The employer’s non-renewal of a yearly contract need not be indicated unless the non-renewal was for cause as listed above.

4.      I hereby certify that my resignation with my present employer was or will be submitted at least 30 days prior to the beginning of the date stated.  If my resignation has not or will not be submitted 30 days prior to date stated, I certify that any board of education that employed me has waived its right to a 30 days’ notice.  A copy of my letter or resignation or if the said board action is attached or will be provided. (This applies if you are or were employed by another Tennessee public school system and if your termination is or was voluntary.)

5.      I understand that misrepresentation of any of these certifications may subject me to the penalties prescribed in Sections 49-5-406, 49-5-407, and 49-5-411 of the Tennessee Code.

APPLICANT’S STATEMENT

I certify that answers give herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.  Information may be certified by fingerprint sample, a criminal history records check conducted by the Tennessee Bureau of Investigation, of other records check pursuant to Tennessee Code Annotated, Section 49-5-413.  I understand the local Board of Education will require an applicant to pay such costs if the applicant is offered and accepts a position as a professional employee.

The applicant understands that neither this document nor any offer of employment from the employer constituted an employment contract unless a specific document is executed by the employer and employee in writing.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also that I am required to abide b all rules and regulations of the employer.

_________________________________                                                 _______________________________

            Date                                                                                                    Signature of Applicant