Barton Lexa School District Licensed Job Application

Barton-Lexa School District

Licensed Job Application

Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number

E-mail *

Birth Date *

Month Day Year

Social Security Number *

What position are you seeking? *

Ex: 2nd Grade Teacher, High School Math

Do you hold a state certificate? *

Yes No

List all states that you have a certificate for. *

Date of Expiration *

/ Month / Day Year

Certification Level *

Subject area(s) of certificaton *

Have you completed the praxis? *

School Information

Name of High School *

*

Diploma Degree

Date Received *

Month Day Year

Name of College(s) *

*

Diploma Degree

Course(s) (Maj./Min.) *

Date Received *

Month Day Year

Semester/Hours *

Current Teachers

Kind of School

Location

Position, Subjects, or Grade Level

Date Hired

Month Day Year

Length of Employment

Years

Beginning Teachers

Kind of School

Location

Position, Subjects, or Grade Level

References

Please give name, position, present address, zip code, and telephone number or 3 persons who would be able to evaluate your work capabilities related to this application. (Give your most recent employer.)

Reference 1 *

Reference 2 *

Reference 3 *

Are you employed? *

Yes No

Have you determined to leave your present position? *

Yes No

Are you under contract? *

Yes No

Why are you leaving your present employer? *

When can you begin work? *

Month Day Year

Have you ever been convicted of a felony? *

Yes No

If yes, please explain.

Are you currently on the child maltreatment registry? *

Yes No

Do you have any physical or mental conditions which would prevent you from performing any of the normal job functions for which you are applying? *

Yes No

Are you a veteran or the spouse of a veteran? *

Yes No

Act 444 of 2013 requires the Barton-Lexa School to provide preference to veterans and veterans' spouses in the areas of applications and hiring. In order to receive the preference, you must complete this section of the Certified Job Application at attch all required documents.

Please select the category that best describes you.

A veteran under age fifty-five (55) A veteran who is over the age fifty-five (55), disabled (it is not necessary that the disability is service-connected), and entitled to a pension or compensation under existing laws A veteran that suffers from a service-connected disability Spouse of a deceased veteran who is unmarried at the time of hiring Spouse of a veteran who suffers from a service-connected disability

Form DD-214 indicating honorable discharge

A letter dated within the last six (6) months from the applicant's command indicating years of service in the National Guard or Reserve Forces as well as the applicant's current status.

Birth Certificate

Marriage License

Death Certificate

Disability letter from the Veteran's Administration, in the case of an applicant with a service-related disability.

In the case of a veteran who is over the age fifty-five (55), disabled (it is not necessary that the disability is service-connected), and entitled to a pension or compensation under existing laws, a letter from the veteran's physician indicating disability, dated within the last six (6) months.

If you would like to submit the required documentation for Act 444 of 2013 differently than attaching them to this application, please describe how you would like to submit the information.

Mail to the school or hand deliver to the school

Cover Letter

Resume

You may contact Barton-Lexa School District at P.O. Box 97, Barton, Arkansas 72312 or call 870-572-7294.

Enter the message as it's shown *

Basic Information

Education

Previous Work Experience

Other Information

Cover Letter and Resume