CHECK: Full-time Teaching Position Part-time Teaching Position Substitute Teaching Other Date of Application:   How did you find out about us?

Name:      E-mail : 

Present Address: 

City:      State:      Zip code:  

Present Position of status:       
Are you presently under contract with any school district for the next school year?   Yes No

Reason for leaving present position:    

When will you be available for employment?    

II. POSITION DESIRED (Indicate 1st and 2nd position preference with numbers.)

Elementary (K-6) Grade
Librarian
Nurse
Guidance Counselor
Psychologist Special Ed
High School
Instructional Assistant
Substitute Teacher (with minimum of 60 credits)
Administrative Position

III. PROFESSIONAL DEVELOPMENT

List the staff development training (in the fields of instruction, classroom management, child development,
human relations, etc.) that you have received in the past three years: (Student teaching may be included).

Topic:   Date
Topic:   Date
Topic:   Date
Topic:   Date

IV. ACTIVITIES

State experience of qualifications for supervising or coaching such activities as athletic teams, choral or instrumental groups,dramatics, yearbook, science, business, or photography clubs, etc.

Are you willing to accept extracurricular or extra duty pay assignments such as class advisor, coaching, etc.? Yes No
  

V. EDUCATION AND PROFESSIONAL TRAINING

Undergraduate College or University
   Name of School   
  City & State       From      To 
  Semester hours      
  Year of Graduation  
  Degree  

Graduate College or University
  Name of School   
  City & State      From  To 
  Semester hours 
  Year of Graduation 
  Degree 

  Certification:  Yes No   If "yes" what state? 
  Type of Certificate
  Subject(s), Grade(s) or Area(s)in which you are certified  

VI. PROFESSIONAL EXPERIENCE

List most recent experience first. Indicate all professional experience that will assist LEAP Academy determine placement.

  Name of School  
  City & State & Zip  
  Name & address of principal/superintendent  
  Dates From-To   Grade and/or subject   Total months 


  Name of School  
  City & State & Zip  
  Name & address of principal/superintendent  
  Dates From-To   Grade and/or subject   Total months 


  Name of School  
  City & State & Zip  
  Name & address of principal/superintendent  
  Dates From-To   Grade and/or subject   Total months 


  Name of School  
  City & State & Zip  
  Name & address of principal/superintendent  
  Dates From-To   Grade and/or subject   Total months 


  Name of School  
  City & State & Zip  
  Name & address of principal/superintendent  
  Dates From-To   Grade and/or subject   Total months 

  Gaps in the above Employment Record (please explain, include dates):

VII. REFERENCES