Crawford Public Schools
908 5
th
Street, Crawford Nebraska 69339
Phone (308) 665---1537 / Fax (308) 665---1909
Email application to: teresa.mcginnis@cpsrams.org
Application for Certified Position
Personal Information
Last Name, First Name, MI
Street Address / P.O. Box City, State Zip
_____________________________________________
Phone
___________________________________________
Email Address
Areas of Interest / Application for Listed Positions
Identify the position(s) for which you are applying.
1
Professional Preparation
Name(s) of
Date Completed
Degree or Diploma
Major / Minor
College/University
and Location
2
Work Experience
Name of School and
Phone Number
Inclusive Dates
Specify Grade
Location or
and/or Subject
Business
Area, Special
Assignments or Job
Title
3
List Job Related Professional Societies, Licenses, Honors,
and Awards
Reason for Leaving Last Position and for Applying for this
Position
Please complete if you have taught for five years or less
Student Teaching
Phone Number
Dates
Grade Subject /
Name Of School and
Supervisor
Location
4
Other Relevant Experiences
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?
YES NO
5
Professional References
Include a minimum of three individuals who have current knowledge of your
professional experience(s) and associated skills.
Name Position Address Phone Number
If presently employed, may we contact your employer?
Yes No
6
Describe effective teaching techniques, which result in
significant learning.
What are the qualities of an excellent classroom teacher?
7
What separates you from the other individuals applying
for this position?
8
What type of Nebraska Teaching Certificate do you hold or
will be able to obtain?
Administrative & Supervisory
Teaching
Special Services
Counseling
Please identify the level of Nebraska Certificate
you possess or will be eligible for.
Professional Standard Substitute
Initial Provisional Temporary
Expiration Date: ____________________________________________________
9
If you hold and out of state certificate, please designate which
state(s).
If you hold a conditional permit, please explain.
If you do not yet hold a Nebraska teaching certificate, please state
the status of your application process.
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
If yes please provide a brief explanation.
NOTE TO APPLICANT: Responding “yes” to the previous question is not an
automatic bar to employment. The date of the offense and other the other
relationship between the offense and the position for which you are applying will
be considered.
10
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
YES NO
I EXPRESSLY AUTHORIZE THE RELEASE TO CRAWFORD PUBLIC
SCHOOLS THIS APPLICATION AND 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 CRAWFORD PUBLIC SCHOOLS
AND ANY PERSON (S) EMPLOYED BY CRAWFORD PUBLIC SCHOOL
DISTRICT FOR ANY CLAIMS OF LIABILITY WHICH YOU MAY EVER
HAVE RELATING TO INFORMATION PROVIDED TO CRAWFORD
PUBLIC SCHOOLS AS PART OF THIS APPLICATION FOR
EMPLOYMENT.
YES NO
11
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 process.
I
hereby declare the information provided by me in this application for employment is true, correct, and
complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on
this application shall be considered cause for dismissal.
I authorize you to obtain a reference report from my current and former employers, and others who are
acquainted with my abilities, and I hold them harmless from liability with the regard to the information they
provide in such written/verbal reports. These reports, if obtained, may include information as to my
character, general reputation, personal characteristics and mode of living. I understand I have the right to
make a written request within ninety (90) days of my application to receive additional detailed information
about the nature and scope of any such investigation.
Additionally, I give my permission for administration, board members, and members of the selection team to
examine any and all information, if required by the district.
This application for employment may be extended for a period of twelve (12) months after which it shall be
deleted from school files. The application may be extended for a period of one year upon written request.
After that, a new application must be submitted.
I understand that neither this document nor any offer of employment from the employer constitute an
employment contract unless a specific document to that effect is executed by the employer and employee in
writing.
Date: __________________________________
Name: ______________________________________________________________________
Signature: __________________________________________________________________
Please email your application form and materials to
superintendent, t
eresa.mcginnis@cpsrams.org or mail them to:
Teresa Mcginnis-District Bookkeeper
Crawford Public Schools
908 5th St.
Crawford, NE 69339
12
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