Certified Staff Application

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…

Name*

Address*

Email*

Phone*

NBC Position of Interest

Are you a former NBC Public Schools Employee?*

Yes

No

Date of Separation

Date Available to work with NBC Public Schools*

Certification*

None

Valid Nebraska teaching certificate

Others

Expiration Date

Area of Specialization/Endorsements

Upload copy of current teaching certificate. (Front and Back)

Activities: Check any of the following which you would be willing to sponsor, direct, coach or manage.

Basketbal - Boys

Basketball - Girls

Cross Country - Boys

Cross Country - Girls

Football

Golf - Boys

Golf Girls

Softball

Track - Boys

Track - Girls

Volleyball

Wrestling

Cheer/Dance

Class Sponsor

Drama

FBLA

FFA

FPS

Instrumental Music

Math Counts

National Honor Society

NB Club

Quiz Bowl

Science Club

SOS (Concessions)

Spanish Club

Spirit Club

Speech

Student Council

Unified Bowling

Vocal Music

Yearbook

A. High School(s) Attended

High School Attended*

Grades Attended*

Special Honors or Recognition*

High School Attended

Grades Attended

Special Honors or Recognition

High School Attended

Grades Attended

Special Honors or Recognition

B. Student Teaching

School/ Location

Date Range Student Taught

Cooperating Teacher

Grade & Subject

School/ Location

Date Range Student Taught

Cooperating Teacher

Grade & Subject

C. College or Universities Attended

Name of Institution (City,State)

Major & Hours

Minor & Hours

Years Graduated

Degree

GPA (4.0 scale)

Special Honors or Recognition

Name of Institution (City,State)

Major & Hours

Minor & Hours

Years Graduated

Degree

GPA (4.0 scale)

Special Honors or Recognition

Name of Institution (City,State)

Major & Hours

Minor & Hours

Years Graduated

Degree

GPA (4.0 scale)

Special Honors or Recognition

D. Educational Work Experience - Include at least the last five employers

School (City/State)

Years Taught

Subject and Extracurricular Duties

Reason for Leaving

School (City/State)

Years Taught

Subject and Extracurricular Duties

Reason for Leaving

School (City/State)

Years Taught

Subject and Extracurricular Duties

Reason for Leaving

School (City/State)

Years Taught

Subject and Extracurricular Duties

Reason for Leaving

School (City/State)

Years Taught

Subject and Extracurricular Duties

Reason for Leaving

References

List names and addresses of persons who are qualified to answer questions concerning your fitness for the position you seek. Include especially supervisors, principals and superintendents under whom you have taught in the past 15 years. If you have not taught previously, include the names of cooperating teachers, college or university supervisors and building principals who have been associated with your student teaching. Indicate with an (*) any reference which is included in your credentials.

NOTE: Please include or have references sent. Be certain that they are up to date. It is important to include evaluations from principals, superintendents, or supervisors under whom you have taught or worked.

Name

Position

Contact Info: Telephone & Complete Mailing Address

File Upload

File Upload

Name

Position

Contact Info: Telephone & Complete Mailing Address

File Upload

File Upload

Name

Position

Contact Info: Telephone & Complete Mailing Address

File Upload

File Upload

Name

Position

Contact Info: Telephone & Complete Mailing Address

File Upload

File Upload

Veteran Preference

If you wish to be considered for a Veterans Preference please indicate ___ Yes ___ No, and submit the appropriate documentation with your application. Note: This section is optional; you need to request a Veterans Preference even if you are eligible, and if you do not request the preference, you need not submit information about your veteran status.

Applicant Veteran?

Yes

No

If yes, submit DD Form 214.

Disabled Veteran?

Yes

No

If yes, submit DD Form 2014 and Veteran's disability verification.

Spouse of 100% Disabled Veteran?

Yes

No

If yes, submit DD Form 214, veteran's disability verification and proof of marriage.

Spouse of Veteran on active duty at this time or within 180 days of the spouse’s discharge or separation of service.

Yes

No

Questions

1. Eligibility for Hire

Are you now under contract? *

Yes

No

If yes, with which school are you under contract & why do you wish to leave your current position?

2. Interest in NBC

Have you previously filed a written application for employment with NBC Public Schools?*

Yes

No

If yes, give date:*

Why do you want to be employed at NBC Public Schools? *

What experiences have you had with NBC Public Schools or the community of North Bend?*

3. Prior History

Have you ever had failed or refused to fulfill a contract of employment with any school district?*

Yes

No

If yes, describe:

Have you ever had a diploma, credential, or certificate denied or revoked?*

Yes

No

If yes, describe:

Personal Disclosure

Respond to EACH item. If there is no response to any item, or if the required attachments do not accompany your application, your application WILL BE REMOVED FROM CONSIDERATION. Information provided in this disclosure will not automatically bar you from employment but will be considered in view of all relevant circumstances.

1. Have you ever received a ticket, been charged with, or been convicted of, a criminal offense relating to sexual or physical abuse?*

Yes

No

2. If you answered “Yes” to Question #1 above, you must explain each situation including location(s), date(s), agency(ies) involved, and the outcome of the each ticket, charge, or arrest (use an attachment if needed):

3. Have you ever had any license, permit, or certificate terminated, revoked, suspended, received a private or public reprimand or admonishment from a licensing agency or been subject to a judicial restraining or contempt order?*

Yes

No

4. If you answered “Yes” to Question #3 above, you must attach an explanation of each situation including location(s), date(s), agency(ies) involved, and the outcome of the each situation (use an attachment if needed):

5. Have you ever been involuntarily terminated or asked to resign, or resigned in lieu of termination from employment?*

Yes

No

6. If you answered “Yes” to Question #5 above, you must explain each situation including the name of the employer(s), the date(s) and reason(s) for the resignation or termination.

Note: School policy requires that a criminal history record information check be completed prior to employment.

Verification

I certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application. I understand it is my responsibility to immediately provide updated, correct information if any of the information changes at any time. I understand that any omission, falsification or misrepresentation made by me on this application or any supplement will be sufficient grounds for failure to employ me or for my discharge should I become employed with the school district. I understand that disclosure of social security number is optional. It will be used to conduct background checks for employment purposes and for personnel and payroll processing and required reporting if I am employed.

Electronic Signiture*

Date/Time*

It is the policy of NBC Public Schools to not discriminate on the basis of sex, handicap or disability, race, color, religion, marital status, veteran status, or national or ethnic origin, or on the basis of genetic information, in its educational programs, admission policies, employment policies or other administered programs. This position is subject to a veterans preference. Persons requiring accommodations to apply and/or be considered for positions with NBC Public Schools are asked to make their request to the Superintendent.

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