Online Job Application

Current Address and Phone Number

Last Name

Middle Initial

First Name

Street Address/PO Box

City

State

Zip Code

Phone

Email

Is your current address the same as your permanent address?

Permanent Address and Phone Number

Street Address/PO Box

City

State

Zip Code

Phone

Professional Preparation

Name of School and Location (Include high school, college, and graduate work)

Date Completed

Degree or Diploma

Major / Minor

Name of School and Location (Include high school, college, and graduate work)

Date Completed

Degree or Diploma

Major / Minor

Experience

Name of School and Location

Phone No.

Inclusive Dates

Specify grade and/or subject area;special assignments

Name of School and Location

Phone No.

Inclusive Dates

Specify grade and/or subject area;special assignments

If not an experienced teacher

Student Teaching

Name of School and Location

Phone No.

Dates

Grade/Subject

Supervisor

Name of School and Location

Phone No.

Inclusive Dates

Specify grade and/or subject area;special assignments

Supervisor

Placement Bureau from which credentials will be sent It is the candidate’s responsibility to request that credentials and transcripts be forwarded to the appropriate school.

Reason for leaving last position

Other Relevant Experience(s)

List special strengths, talents, and/or unique qualities you possess which you believe might be useful in your employment.

Date Available for Employment:

Are you legally authorized to work in the United States Of America:

Personal References

(include a minimum of three who have knowledge of your professional teaching experiences.)

Name

Position

Address

Phone Number

Name

Position

Address

Phone Number

Teaching Certificate

What type of Nebraska Certificate do you now hold or will be eligible for?

Administrative Teaching Special Services

What endorsements and grade levels appear on your certificate?

What rank of Nebraska certificate do you now hold or will be eligible for?

Initial Professional Standard Other

Details:

Expiration Date

If you hold an out-of-state certificate, please designate which state:

If you do not hold a Nebraska certificate (Initial, Standard or Professional), please explain.

Have you ever had a teaching credential, license, or other document authorizing school service or teaching, suspended, revoked, voided, denied, rejected, or voluntarily surrendered? Yes No

Note to Applicant: Responding “yes” to the previous question is not an automatic bar to employment. The date of the offense, and the relationship between the offense and the position for which you are applying will be considered.

If yes, where?

RELATED FILES

You can use this section to upload any related files. Allowed formats are doc, docx, pdf, xls, xlsx, and txt

AUTHORIZATION AND RELEASE

I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVIDED ARE TRUE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

YES NO

I EXPRESSLY AUTHORIZE THE RELEASE TO THE EDUCATIONAL AGENCY RECEIVING THIS APPLICATION ANY RECORDS OR INFORMATION WHICH MAY REFER OR RELATE TO THIS APPLICATION FOR EMPLOYMENT, INCLUDING, BUT NOT LIMITED TO, RECORDS OF EDUCATIONAL INSTITUTIONS, LAW ENFORCEMENT OR CRIMINAL JUSTICE AGENCIES, AGENCIES MAINTAINING CHILD ABUSE RECORDS, AND PREVIOUS EMPLOYERS. I HEREBY RELEASE AND DISCHARGE THE EDUCATIONAL AGENCY RECEIVING THIS APPLICATION AND ANY RESPONSIBLE PERSON(S) EMPLOYED BY THE AGENCY FROM ANY AND ALL CLAIMS AND LIABILITY WHICH I MAY HAVE OR EVER CLAIM TO HAVE RELATING TO INFORMATION PROVIDED TO THE EDUCATIONAL AGENCY AS PART OF THIS APPLICATION FOR EMPLOYMENT.

YES NO

Signature of Applicant

At the time of the personal interview the Applicant will be asked to sign any needed and necessary releases as a part of the interview process and/or employment. The interviewing Educational Agency may forward the Applicant Authorization and Release forms as a part of the interviewing process.

Date

Name

Signature

School districts reserve the right to request additional paperwork or information pertinent to the position for which the applicant is making application.

I am a human.

Elementary Teacher

Current Address and Phone Number

Permanent Address and Phone Number

Professional Preparation

Experience

If not an experienced teacher

Student Teaching

Reason for leaving last position

Other Relevant Experience(s)

Personal References

Teaching Certificate

RELATED FILES

AUTHORIZATION AND RELEASE

Signature of Applicant