2015 Summer School Teacher Application

Application Deadline: March 23, 2015

2015 SUMMER SCHOOL TEACHER APPLICATION

Dates vary by program; please refer to the posting and to Summer School registration information available at www.worthington.k12.oh.us

Print, complete and return this application to: Karen Meador, Office of Professional Development, 200 East Wilson Bridge Road, Worthington, Ohio 43085.

ALL SUMMER SCHOOL TEACHER APPLICANTS NEED TO FILL OUT THIS PAGE INTERNAL APPLICANTS (CURRENT WORTHINGTON EMPLOYEES) COMPLETE THIS PAGE ONLY

Name: ______

Home Address: ______City: ______

State: ______ZIP: ______Home Phone: ______Cell Phone: ______

E-Mail Address: ______

PRESENT TEACHING ASSIGNMENT:

School District: ______Part Time/Full Time: ______

Licensure Area(s): ______

Subject(s) Taught: ______

School Building and Telephone Number: ______

SUMMER SCHOOL POSITION PREFERRED: (List the specific position[s] for which you are applying in order of Preference):

Course Title Term Preference

First Choice:______

Second Choice:______

Third Choice:______

Have you taught in the Worthington Summer School Program in the past? Yes ( ) No ( )

ARE YOU INTERESTED IN SUMMER SUBSTITUTE TEACHING: YES ( ) NO ( )

- 1 - ONLY EXTERNAL (NON-CURRENT WORTHINGTON STAFF) SUMMER SCHOOL TEACHER APPLICANTS NEED TO FILL OUT THIS PAGE

Legal Information

 Have you been a continuous Ohio resident for the past (5) years: Yes ( ) No ( )

 Have you ever been convicted of, found guilty of, or pled no contest to any misdemeanor other than a traffic offense? Yes ( ) No ( )

 Have you ever been convicted of, found guilty of, pled guilty to, or pled no contest to any felony? Yes ( ) No ( )

 Have you ever had a criminal conviction sealed or expunged? Yes ( ) No ( )

 Have you ever had ANY professional certificate, license, permit, or an application for the same, revoked, suspended, limited or denied? Yes ( ) No ( )

 Have you ever surrendered ANY certificate, license, or permit, other than a driver’s license? Yes ( ) No ( )

If you answer YES to any of the above, please explain details below:

I acknowledge being informed that, as a precondition to employment in the position for which I am applying, I must in accordance with Ohio law both provide a set of fingerprints and satisfactorily pass a criminal records check if I come under final consideration for employment. I recognize that I will be charged for the cost of the records check such amount as the Bureau of Criminal identification and investigation and the Federal Bureau of Investigation may charge the school district ($50 fee cash or money order, made payable to Worthington Schools) and unless I pay the fee, I will not be considered for employment.

I hereby authorize the Worthington Schools to obtain from my former employers all data needed to support this application.

I represent that all information furnished in connection with this application is true and accurate to the best of my knowledge. I further recognize that, should the employer discover that I have falsified any such information, I will not be hired or, if already hired, will be subject to termination from employment on that ground.

______Applicant’s Signature Date

The District provides equal opportunities for employment, retention and advancement of all personnel regardless of national origin, citizenship status, religion, sex, economic status, age, disability or other human differences.