IRWIN COUNTY BOARD OF EDUCATION P. O. BOX 225 OCILLA

IRWIN COUNTY BOARD OF EDUCATION
P. O. BOX 225
OCILLA, GEORGIA 31774
For Office Use Only
APPLICATION FOR EMPLOYMENT
Date Hired
Date Applied
Date Interviewed
Date available for employment
Name
SSN
Permanent Address
Mailing Address (if different)
Phone (Home)
(Cell)
For position as
PLEASE ATTACH A RESUME AND INCLUDE THREE REFERENCES.
Yes … No …
Have you completed The Teacher Insight Interview?
University/College(s) administering degrees:
Undergraduate
Graduate
Do you presently hold a Valid Teaching Certificate? Yes
… No …
Applied … State
Level
Field
Have you passed the appropriate Georgia Certification test?
Yes … No …
FieldsTaken:
PRAXIS I:
Yes … No … Awaiting Results … Fields Taken
PRAXIS II:
Yes … No … Awaiting Results … Fields Taken
GACE:
Yes … No … Awaiting Results … Fields Taken
Have you ever been dismissed from employment
with a school system, or asked to resign in lieu of dismissal? Yes … No …
Have you ever received an unsatisfactory annual performance evaluation? Yes … No …
If yes, explain:
Have you ever had a teaching certificate or credential denied, revoked or suspended? Yes … No …
If yes, explain:
Areas of certification and concentrations
Grade and/or subject preferences
VIEWPOINT
Please use additional sheets to express in your own handwriting your views on a current development or issue in
education or in your specific subject field.
CRIMINAL CONDUCT
Have you ever been arrested for any crime or been named in an indictment, accusation,
or special presentment of any offense, other than a minor traffic violation?
Yes … No …
If “yes,” attach an explanation.
Have you ever been convicted of any crime, entered a plea of guilty, nolo contendere,
suffered first offender adjudication, or any similar criminal, quasi-criminal or adjudications?
Yes … No …
If the answer is “yes,” state the name and address of the court, the date of the alleged offense, a description of the
charges, and an explanation of the final action taken, including any fines, probation, imprisonment, first offender
adjudication, or similar disposition.
CRIMINAL RECORD CHECK CONSENT and AFFIRMATION
I understand and agree to a criminal record check as provided by O.C.G.A. 20-2-211, by the policies and rules of the
state board of education, and by this board of education. I agree to sign the appropriate forms which the law
enforcement agency may require to give consent for a criminal record check through the National Crime
Information Center and the Georgia Crime Information Center. If offered a contract of employment, I understand
that I will be issued only a temporary contract pending the outcome of a criminal record check. I understand that
fingerprinting and applying for a background check will take place at the Ocilla Police Department and Irwin
County Detention Center, and that I will be responsible for all charges incurred.
I understand that the Irwin County School System may contact any or all of the references, as well as other
principals, supervisors, or acquaintances. I understand that any misrepresentation, falsification or omission of facts
to include criminal record will be sufficient cause for cancellation of the application or termination of employment.
I understand that the information given herein becomes a legal part of the contract should I become employed by the
Irwin County School System. I further understand that this application and all materials related to it become
the property of the Irwin County School System and are not available to the applicant. I hereby affirm that the
information given by me in this application is true and complete to the best of my knowledge and belief.
SIGNATURE
Date
The Irwin County Board of Education does not discriminate on the basis of race, age, color, national origin, sex or
disability in education programs, activities and employment.