Employment Application

Please return application to :
Mr. Mark LaFountain
Assistant Superintendent for Personnel
Center for Instruction, Technology & Innovation
179 County Route 64
Mexico, NY 13114

Position Applying for :Teaching Assistant Substitutes
Personal Information


First Name: Last Name: Middle: 
 
Address: City: State: Zip:
Phone Number: Email: Retirement No.:
(voluntary)
Have you ever been convicted of a crime?*
If yes, explain
*(A conviction will not necessarily disqualify an applicant for employment.)

Finger printed pursuant to Part 87 of the Regulations of the Commissioner of Education ?
(Criminal/History Record Check for Prospective School Employees & Applicants for Certification)?

Dishonorable Discharge?


Certification/License


New York State Teaching/Teaching Assistant/Administrative Certificate(s)
Subject Area: Type:* Effective Date: Expiration Date:
*Teaching/Administrative: Provisional, Permanent, Initial, Professional, Transitional
Teaching Assistant: Temporary, Continuing, Level I, Level II, Level III, Pre-Professional

Other licenses held: type and issuing authority




NYSTCE Test Results(Teachers only)


New York State Teaching/Teaching Assistant/Administrative Certificate(s)
Test: Taken: Passed




Educational Preparation


Name and Location of High School Nature of Studies Graduate ?
   
Name and Location of College Nature of Studies Degree Graduate ?
Name and Location of College(Graduate) Nature of Studies Degree Graduate ?
Name and Location of Vocational/Technical/ Trade School Nature of Studies Degree Graduate ?


Teaching or Administrative Experience


Dates Employed Employer's Name Employer's Address Position Reason for Leaving


Other Work Experience


Dates Employed Employer's Name Employer's Address Position Reason for Leaving


Civil Service Status


Some positions in BOCES are competitive civil service positions. Appointments must be made from the appropriate eligible lists supplied by the Oswego County Department of Personnel.
Tested by the Oswego County Civil Service Department ?
If yes, indicate what test(s) and dates taken.


Tenure Status


Were you ever appointed on tenure in a public school district in New York?
If yes, complete the following.
Tenure Area Effective Date
Were you ever dismissed from the school district conferring tenure pursuant to Education Law Section 3020a?
Name and Address of School District where tenure was granted


Professional & Scholastic Organizations, Memberships, Honors


Exclude organizations, the nature or character of which indicates the race, creed, color or national origin of its members.


Other Skills and Abilities


For example: coaching, knowledge of sign language, technology skills.


References


List three individuals having personal knowledge of your professional training, ability, experience and personal character. Include the name, address and telephone of your last supervisor who may be contacted for a personal or professional reference.
Name Position Address Phone
May we refer to your present employer?
May we refer to your former employer?
Placement folder may be secured from:(Name and Address).


Applicant's Statement


Give any additional information which you think might be of value in considering you for a position.