APPLICATION FOR PROFESSIONAL EMPLOYMENT

LATTA SCHOOL DISTRICT
205 King Street
Latta, South Carolina 29565
Phone: 843-752-7101
Fax: 843-752-2081

THIS APPLICATION REMAINS ACTIVE FOR THE CURRENT SCHOOL YEAR ONLY.
RENEWALS MUST BE MADE IN PERSON, BY MAIL, OR BY PHONE.

Applicant



Present Address




Permanent Address




Other Contact Information




Can you submit proof of U.S. citizenship?     Yes     No
If not, please explain:

Have you ever been convicted of a felony or misdemeanor
other than a minor traffic offense?     Yes     No
If yes, please explain:

Are you currently under contract?     Yes     No
If yes, please state when and where:

Why do you want to leave your current position?

Do you possess current professional certification as a teacher?     Yes     No
Certificate Number:
Years Experience:
Date Issued:
Date Expires:
Issuing State:
Degree on which certification was based:       BA       BA+18       MA       MA+30       DR

Subjects and grade levels certified to teach:

Educational Preparation - High school and beyond
Name of
School

City/State
Start
Date
End
Date

Degree

Major

Professional Experience
Name of
School

City/State
Employed
From-To

Grades

Subjects
Reason for
Leaving

Other Work Experience (Full Time Only)

From/To
Business
Name

City

State

Type of Work
Reason for
Leaving

Are you active in the National Guard or Reserve?     Yes     No
If so, to what extent?
Branch of Service:         Dates (month/yr to month/yr)

List any additional part-time or voluntary child-related work experience:

List participation in organizations and offices held:

List any extracurricular activities, sports, clubs, or activities
you would be interested in conducting:

References
Give the name and address of three persons competent to speak of you as a teacher. Include present principal, department chair, and supervisor.

Ref 1 Name

Position

Institution

Street

City

State & Zip
Email:       Phone:


Ref 2 Name

Position

Institution

Street

City

State & Zip
Email:       Phone:


Ref 3 Name

Position

Institution

Street

City

State & Zip
Email:       Phone:

Use the space below for a personal statement, giving your estimation of your qualifications (strengths and weaknesses).

Use the space below to explain how employing you would benefit the Latta School District.

The following information must be available for consideration of candidacy.
  • College Transcripts (First Year Teachers Only)
  • Teaching Certificate


READ CAREFULLY BEFORE SIGNING and SUBMITTING

My signature below indicates that I have completed this application for employment accurately and truthfully.
I understand that misrepresentation of factual information is cause for dismissal should the Latta School District
employ me.

SIGNATURE:       DATE:

Latta School District does not discriminate in the employment of staff based on sex, race, age, or handicapping conditions.
The district complies with the requirements of Title IX of the 1972 Education Ammendment, Section 504 of the
Rehabilitation Act of 1973, and Title VI of the Civil Rights Act of 1964 as well as other applicable civil rights laws.

You are not required to disclose information about physical or mental limitations that you believe will not interfere
with your ability to do the job. On the other hand, if you want the employer to consider special arrangements to accommodate
a physical or mental impairment, you may identify that impairment in the space below and suggest the kind of accommodation
you believe would be appropriate.

PLEASE PRINT THIS DOCUMENT BEFORE YOU HIT THE SUBMIT BUTTON.
You will not be able to make corrections or changes to this document once you click submit.