Practice Teaching (Fill in
only if you have less than 2 years of actual teaching experience)
School District Address:
Name of Cooperating Teacher:
From:
Month:
Year:
To:
Month:
Year:
Name of
College/University
Supervisor:
Grade or Subject:
Certification in State of New Jersey (Please check appropriate certification held)
Administrator
Art
Bilingual Education
Biology
Business Administrator
Business Education
Chemistry
Computers
Early Childhood (P-3)
Elementary (K-5)
Elementary (K-8)
Family Consumer Science
General Science
Gifted and Talented
Guidance
Industrial Arts/Tech Ed
Instrumental Music
Italian
Language Arts
Learning Disability Teacher-Consultant
Library (Media)
Math
Middle School Content Endorsement
Physical Education/Health
Physical Science
Principal
School Nurse
School Psychologist
Science
Social Worker
Spanish
Speech Language Specialist
Supervisor
Teacher of the Handicapped
Vocal Music
Teaching Experience ( List
Chronologically)
School Year
Length of
Service
Name/ Address/Telephone
of School
Position
Held
Years
Months
Work Experience (Other than
Teaching)
From
Month / Year
To
Month / Year
Name/Address/
Telephone of Employer
Position
Held
Active Military Service (Not
Reserve Status)
From
Month / Year
To
Month / Year
Months In Service
Branch of
Service
Job
Classification
Rank
Professional References
Include the names of superintendents, principals and
professors who have knowledge of your personal and
professional competence. If you are an experienced teacher,
include superintendents and principals for whom you have
taught. (DO NOT include relatives.)
Reference 1
Include Name, Official Position, School District Address and
Telephone Number.
Reference 2
Include Name, Official Position, School District Address and
Telephone Number.
Acknowledgement and Release of Information
I understand that, at some point in the
selection process, some or all of the information contained
in this application could become public and the facts set
forth herein are subject to verification.
I hereby authorize the West New York Board of Education to
investigate my background as part of the application
process. It is the intent of such authorization to provide
full and free access to information for the specific purpose
of pursuing a background investigation which may provide
pertinent data for the West New York Board of Education to
consider in determining my suitability for employment.
I understand that if I am employed by the West New York
Board of Education, I will be required to submit to a state
and national criminal history record check, and I will be
required to submit to fingerprinting, at my expense, for
purposes of submitting my fingerprints to the Federal Bureau
of Investigation for a national criminal history check. I
further understand and agree that if I have been convicted
of a crime which has not been disclosed to the West New York
Board of Education, the Board may immediately dismiss me.
I authorize any and all law enforcement agencies, current
and former employers, and academic institutions to supply
any information regarding my background to the West New York
Board of Education, and to its agents and employees. In
consideration of the West New York Board of Education’s
review of this employment application, I hereby release the
West New York Board of Education, its employees and agents,
and all providers of information from any liability
resulting from such investigation or furnishing and/or
receiving such information.
I have read and understand the acknowledgement and release
statement above and agree to its contents. I declare under
penalties of false statement that I have examined this
application and to the best of my knowledge and belief, the
information contained herein is true, complete and accurate.
I understand that falsification of information on this
application form may be grounds for dismissal.
Type your name to confirm your agreement
We are an Affirmative Action Equal Opportunity School
District. The Board does not discriminate with respect to
Age, Gender, Race, Creed, National Origin or Disability
