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Administrative Services Credential-Induction Coach Application Form
Please type/write your name as printed on your social security card.
Dr. Mrs.
Ms.
Mr. Gender: M
F
NAME Las
t: First: Middle:
ADDRESS
City: S
tate: Zip:
Home Phone: Work Phone: Ext.
Cell Phone: Personal Email:
Please answer the following questions:
1. Have you ever inquired, applied, or been a student of Chapman or Brandman?
If yes, when?
2. Have you ever worked or taught for Chapman or Brandman University? If yes, what campus?
3. Are you currently an employee of Brandman?
Please list any other names you have used while employed or attending school (include the dates you used each name).
Indicate soonest availability (mo/yr) and nearest BU campus:
Identify Admin. Clear Credential date:
List Colleges/Universities attended:
Degree Institution Discipline/Major(s) Dates Attended Mo/Year Rec’d
Previous teaching/administrative experience: (CV required at time of application)
Name of School
Yrs./Mos. of
Service Position
I certify that to the best of my knowledge, the information furnished on this application and attached resume/curriculum vita is accurate and
complete. I understand that if I have knowingly misrepresented my teaching qualification any teaching assignment offers will be rescinded. I agree
that if I am given a teaching assignment I will abide by Brandman University’s Adjunct Faculty Policy.
Applicant Signature __________________________________________________(Date)___________________________
Submit form by email -
k12academic@brandman.edu
click to sign
signature
click to edit
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