The Oregon Teacher Application form is a standardized document used by individuals seeking teaching positions within Oregon's school districts. This form collects essential personal information, educational background, teaching experience, and other relevant details necessary for evaluating a candidate's qualifications. It is important to note that individual school districts may require additional information beyond what is included in this application.
The Oregon Teacher Application form is a crucial document for educators seeking employment within the state’s school districts. This comprehensive application gathers essential personal information, including the applicant's name, contact details, and social security number, ensuring that the hiring process is efficient and organized. It prompts applicants to disclose their current teaching licenses, endorsements, and any additional certifications they may hold. Furthermore, the form delves into the applicant's personal history, asking about any past disciplinary actions or legal issues that may impact their eligibility for teaching positions. Applicants are also required to specify their preferred teaching positions and grade levels, which allows school districts to match candidates with suitable roles effectively. Additionally, the form requests detailed educational and work experience, including teaching and student teaching positions, as well as references from previous supervisors. It is important to note that individual school districts may have additional requirements beyond what is outlined in the application. By understanding the components of the Oregon Teacher Application form, potential applicants can prepare thoroughly and present themselves as strong candidates in the competitive field of education.
OFFICE USE ONLY
Expiration Date:_______________________
Applicant’s Name: ____________________________________________________
OREGON
STATEWIDE TEACHER APPLICATION
Dated Received
Produced by Oregon School Personal Association 1994
__________________
(Note: Individual school districts may require additional information other than that asked for on this application.)
PERSONAL INFORMATION
Application Date: __________________________________ Social Security Number __________--________--_________
Full Name ______________________________________________________ Date of Availability _____________________
LastFirstMiddleMonth Day Year
Previous or other surname(s) reflected on employment or educational records ___________________________________
Present Mailing Address ________________________________________________ Phone (____)_____________________
StreetPhone number is unlisted
______________________________________________________________________ Msg. Phone (_____)_______________
City
State
Zip Code
Where you can always be reached
Phone number is unlisted
Permanent Mailing Address _____________________________________________ Phone (_____)____________________
Street
_______________________________________________________________________
Name of contact if other than applicant ______________________________________________________________________
Currently under contract with another school district? YesNo
If Yes: School District _________________________________________________ City ___________________________________________
Current Oregon Teaching License
Type(s) (e.g. Basic D- 474, Temporary, ect.) ___________________________________________________________________________________________
Endorsements(s) (e.g. Physical Education) ____________________________________________________________________________________________
Authorization(s) (e.g. 018) _________________________________________________________________________________________________________
Date of Expiration ________________________________________________________________________________________________________________
Added endorsements expected ______________________________________________________________________________________________________
If no Oregon License, when is it expected? ____________________________________
Month
Year
Full-Time Contract
Part-Time Contract
Temporary Contract
Substituting
Other _______________________________________________
Personal History
Have you ever
Yes No
•been dismissed from a teaching position?
•Had a teaching license revoked?
•Been convicted, pled guilty or pled nolo contendere to a felony?
•Been convicted, pled guilty, or pled nolo contendere to a crime involving child abuse or sexual abuse?
•Had a report of child abuse or sexual activities involving a K-12 student or minor filed against you with a school district,
Children Services Division, a police agency, or in court?
If yes, please explain. _________________________________________________________________________________________________
___________________________________________________________________________________________________________________
POSITION PREFERENCE(S)
Denote any licensed area for which you are applying. List your preference by indicating “1” as your first choice.
Failure to prioritize could adversely affect your chances of being considered.
SPECIALIST
Indicate your grade preference, with 1 being your first choice.
____ Preschool
____ K-5
____ 6-8
____9-12
Check any area(s) for which you are applying
Band
Orchestra
Staff Development
Computer Science
PE
TAG
General Music
PT/ OT
Testing/ Assessment
Librarian/ Media Specialist
Reading
Other ______________________
SPECIAL SERVICES
____ 9-12
Check the box(es) for the area(s) you are licensed to teach and are applying:
Adaptive PE
Nurse
Bilingual/ ESL/ Multicultural
Occupational Therapy
Chapter 1
Other Health Impaired
Counselor/ Child Development Specialist
Psychologist
Development Disabled
Physical Therapy
Drug/ Alcohol Specialist
Sensory Impaired
Handicapped Learner
Severely Emotionally Disturbed
Hearing Impaired
Social Worker
Home Teaching/ Tutoring
Speech/ Language
Learning Disability
Structured Learning Center
Mildly Mentally Retarded
Work Experience
Multi - Handicapped
Other ______________________________
ELEMENTARY
Indicate your grade preference, with 1 being your first choice
____ Early Childhood Ed./ Kindergarten
____ Middle School (with elementary certificate)
____ Primary (grades 1-3)
____ Blended or Multi-Age Classrooms
____ Intermediate (grades 4-6*)
____ Other (see Specialists)
*Grade 6 is in the elementary school in some districts, and in the middle school in others.
SECONDARY
____ 6th (middle school)
____ 7-8
____ Alternative school (6-12)
Check the area(s) for which you are applying and hold endorsement(s)
Agricultural Sci. Tech.
Health
Mathematics
Art
Home Economics
Basic Math
Business Education
Industrial Arts/ Trades/
Advanced Math
Career Education
Technology Ed/ Vocational Ed
Music
Agriculture
Dance
Auto
Drama
Construction
Vocal
Driver’s Education
Drafting
Other ____________________
English/ Language Arts
Graphics
Physical Education
Foreign Language
Metals
Science
French
Technology Ed
Biology
German
Specify ________________
Chemistry
Japanese
Woods
Integrated Sciences
Latin
Work Experience Coord.
Physics
Russian
Other ___________________
Social Studies
Spanish
Speech
Other (see Specialists)
EDUCATIONAL/ WORK EXPERIENCE
EDUCATIONAL AND PROFESSIONAL BACKGROUND
High School, Colleges, Universities
Dates Attended
Type of Degree
Major &
Name, City, State
Mo/Yr to Mo/ Yr
Earned
Minor (if any)
High School
College / University
TEACHING EXPERIENCE
Include only those positions for which a teaching license was required (list most recent first). Approval of experience shall be determined at the time of employment. You will be asked to provide official verification.
District Name
Name
Grade
Subject(s)
Full-Time
Dates of
Total
Reason
Address (Street, City, State)
of School
Taught
Part-Time
Employment
Years
for Leaving
STUDENT TEACHING EXPERIENCE
Please list experiences in a recognized teacher preparation program only.
District Name & School
Grade(s)
Subject(s) Taught
Dates Taught
Supervising Teacher
EXPERIENCE OTHER THAN TEACHING
Do not list military experience here.
Employer
Address
Position
Dates of Employment
REFERENCES
Give references (a minimum of three), especially superintendents or principals under whom you have taught, who have first-hand knowledge of you character, personality, and teaching ability.
Position/ District
Work Phone
Home Phone
TRAINING AND PREPARATION
SPECIAL TRAINING
Please use key to indicate experience or training in any of the following specific classes or workshops.
KEY:
T = Training
E = Experience
T/E = Both
____ Authentic Assessment
____ Equity Awareness
____ Portfolios
____ Child Abuse/ Personal Safety
____ Gifted Education
____ Remedial Education
____ Computer Training
____ Inclusive Education
____ Signing
____ Cooperative Learning
____ Integrated Curriculum
____ Study Skills
____ Conduct Disorders
____ ITIP
____ Task Writing/ Rubrics
____ Critical Thinking Skills
____ Learning Skills
____ Visual/ Manipulative Math
____ Current First Aid Card
____ Middle Level Education
____ Whole Language
____ Curriculum Integration
____ Multi-Age Class
____ Other _________________
____ Development Appropriate Practices
____ Multicultural Awareness
____ Drug Alcohol Problems
____ Peer Coaching
OTHER LANGUAGES: Please list any foreign language(s) you can use. _______________________________________________________
Fluent Skills (speak, read, write)
Minimal skills (please list abilities) _______________________________________________________________________________
____________________________________________________________________________________________________________
Actual language training ____________________________________________________________________________
ELEMENTARY APPLICATIONS: Check areas in which you have training or experience to the extent the skill(s) could be used in class.
Play PianoTeach PETeach ArtTeach Vocal Music
PLACEMENT FILE
Do you have current placement file(s)?
Yes
No
I requested a copy of my placement file to be sent to the appropriate school district.
MILITARY EXPERIENCE
Branch of Service
Job Classification
Inclusive Dates
Type of Discharge
Citizenship: Are you a U.S. citizen or otherwise legally authorized to work in the U.S.?
Health: Is your physical/ mental health condition such that you can fulfill the essential job functions of the teaching/ extracurricular work for which you are
applying (either with or without reasonable accommodations)?
APPLICATIONS
Applications which are forwarded to a school district will remain active at that district for one year. The district will normally keep the application on file for three years. Contact individual districts about procedures for reactivating an application that is more than one year old.
I understand that any omissions on this application may prevent my application from being evaluated or referred to an individual school district. I authorize any school district to which this application is submitted to obtain information about my criminal records. I authorize all government agencies to provide information about my criminal records to the school district. I verify that all information on this employment application is true and complete. I understand that any misrepresentation, falsification, or omission on this application or on other documents submitted to the school district will be sufficient cause for this application not to be considered by the school district, not to be referred to a school district or for discharge if I have employed.
AUTHORIZATION TO OBTAIN AND RELEASE INFORMATION
I authorize any Oregon school district for which I have completed an employment application to check my references, to obtain information from my prior employers and educational institutions, and to take other actions to investigate any information provided in my employment application, and to obtain information relevant to evaluating my qualifications and fitness for a teaching position. I authorize my listed references, past employers and educational institutions, and anyone else who has information about my work history, education qualification or fitness, to provide such information to any school district for which I have completed an employment application. I release the school district to all persons providing information to the school district from any liability whatsoever for obtaining and providing that information, regardless of the results.
Signature ____________________________________________________________________ Date ______________________________________
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