Fillable Call for Interest: Statement of Interest Application Practicum (York University)

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Call for Interest: Statement of Interest Application Practicum (York University)

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Call for Interest: Statement of Interest Application – Practicum Facilitators
This is an ongoing call for interested candidates to submit a Statement of Interest in applying for a position as a
Practicum Facilitator in the Faculty of Education.
Practicum Facilitators act as representatives of the Faculty of Education with partner schools, school
representatives and students (who are sometimes referred to as “teacher candidates”) in order to foster positive
relationships. Practicum Facilitators may be involved in securing appropriate school placements for students and
for holding workshops and information sessions in order to facilitate positive and meaningful learning experiences
for students.
Statement of Interest Application Form:
Personal Information:
Full Name
Date of Application
Availability (Starting date)
OCT number (in good standing)
York University Employee Number (if applicable)
Available during the academic year (August to June), during school hours (8:30 to
5:30), M-F (select one)
Yes No
Qualifications: Completed Degrees
Degree
Subject
Institution
Date of
completion
Qualifications: Basic Qualifications* (ABQ)
Basic Qualification
Subject
Institution
Date of
completion
*Not sure what this means? Check your OCT record online
Qualifications: Additional Qualifications (AQ)
Additional Qualification
(including part 1, 2, or
specialist)
Subject
Institution
Date of
completion
K-12 Teaching Experience:
Month/Year
Subject(s)
School
Board
Panel
To
PJ, JI, IS
Post-Secondary Teaching Experience:
Month/Year
Subject(s)
School
Board
Panel
To
PJ, JI, IS
Administrative Experience/Positions of Responsibility:
Month/Year
Role
School
Board
Panel
To
PJ, JI, IS
Experience Working with Teacher Candidates (e.g., as a Mentor Teacher)
Month/Year
Role
School
Board
Panel
To
PJ, JI, IS
Experiential Education Experience
S
uccinctly list any Cooperative Education and other related workplace-based learning you have completed and/or led.
Statement of Interest:
Why are you interested in being a Practicum Facilitator in the Faculty of Education at York University? (Be succinct!)
Personal Philosophy of Education: (Be succinct!)
Description of how you Implement your Philosophy of Education in Practice: (Be succinct!)
Statement of Understanding Regarding Criminal Record Check:
I understand that in order to be a Practicum Facilitator, I will need to complete and maintain annually a Criminal
Record Check with Vulnerable Sector Screening. I understand that this is a legal requirement and not negotiable.
Yes
No
Statement of Understanding Regarding Teaching License:
I understand that in order to be a Practicum Facilitator, I will need to maintain my membership with the Ontario
College of Teachers (OCT) in good standing.
Yes
No
Confirmation of Understanding Regarding the Role:
I understand that this is not a teaching position, but a Practicum Facilitator position, which is outlined
above.
I confirm that I am comfortable with and able to use technology regularly, including email, online
databases, completing online forms, and using other online communication tools (e.g., Skype, Zoom).
I confirm that I have access to a vehicle in order to travel to and between schools and other related
settings.
I understand that if I am eligible for a particular position that becomes available, I will be contacted by the
Practicum Office. Otherwise, I understand that I will not be contacted.
Statement of Understanding Regarding Hiring Process:
I understand that by submitting this Statement of Interest Application Form that I am not applying for a specific
job, but indicating my interest in being contacted in the event that a position becomes available.
Collection of Information:
I accept the University’s right to collect pertinent personal information. I declare that the information I have
provided in this Statement of Interest Application form and submitted document(s) is true, complete and accurate
in all respects, and that all available information requested in this application has been disclosed. All information I
have provided in connection with this Statement of Interest Application form is subject to verification and audit by
York University. I understand that any false or misleading information given by me in this Statement of Interest
Application form and any documents submitted may be sufficient cause for rejection of my application or dismissal
after employment. I understand and acknowledge that the information is collected and used to establish my
employee record for the purpose of administering Payroll, Benefits, and Pensions, and is used by the University in
the academic and financial administration of its affairs, and to achieve compliance with its collective agreements
and legislative obligations.
Yes
No
Freedom of Information and Protection of Privacy Act (FIPPA)
Personal information submitted for purposes of indicating interest in applying for a position as a Practicum
Facilitator is collected under the authority of Freedom of Information and Protection of Privacy Act (FIPPA) and The
York University Act, 1965. The information will be used to inform eligible candidates about positions that may
become available, and for contacting the individual for matters related to the York University’s Faculty of
Education’s Practicum Facilitator hiring process. The information is kept in confidential files and will be discarded
after approximately two years of storage each September. If you have any questions about the collection of this
information by the Faculty of Education, please contact Laura Crane, Faculty of Education, York University, 4700
Keele Street, Toronto, ON M3J 1P3, telephone 416-736-2100 extension 20053.
By submitting this completed form, you agree to the following:
I accept the University’s right to collect pertinent personal information. I declare that the information I have
provided in this Statement of Interest Application and submitted document(s) is true, complete and accurate in all
respects, and that all available information requested in this Statement of Interest Application has been disclosed.
All information I have provided in connection with this Statement of Interest Application is subject to verification
and audit by York University. I understand that any false or misleading information given by me in this Statement
of Interest Application form and any documents submitted may be sufficient cause for rejection of my Statement
of Interest Application or dismissal after employment. I understand and acknowledge that the information is
collected and used to establish my employee record for the purpose of administering Payroll, Benefits, and
Pensions, and is used by the University in the academic and financial administration of its affairs, and to achieve
compliance with its collective agreements and legislative obligations.
Signature
Date of Submission
Please send your completed form to the Faculty of Education at experientialeducation@edu.yorku.ca.
Please be reminded that you will only be contacted directly if there is a position available for which you are
qualified.
We are unable to provide feedback on how to complete this form or to advise you on the content to include in this
form.
Thank you for your interest in working with us!
click to sign
signature
click to edit
Employment Equity:
Completion of this section is voluntary; it will be removed from your Statement of Interest Application and provided
to the Human Resources Department for storage.
As part of York’s commitment to employment equity, we ask all applicants to complete the employment equity
self-identification questions in order to ensure that York’s working environment remains diverse and inclusive.
Studies have shown that student success is closely tied to the ability of students to see themselves reflected in the
institution’s faculty and administration. Additionally, work environments greatly benefit from increased diversity.
Self-identifying is voluntary. Your information is kept confidential; the data from the survey can only be accessed
by the Equity, Diversity & Inclusion Officer in Human Resources (HR). The information is used in aggregate form for
employment equity purposes.
If you have questions about employment equity or about the self-identification questions, please contact Annette
Boodram, Equity, Diversity and Inclusion Officer at equity@yorku.ca or (416) 736-2100 x 20848.
We encourage you to self-identify by checking the appropriate box(es):
Aboriginal (Indigenous) Persons
Persons with Disabilities
Women
Visible Minorities (Racialized)
LGBTQ2 (Lesbian, gay, bisexual, transgender, two-
spirited, genderqueer, questioning, or who otherwise
express gender or sexual diversity)
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Call for Interest: Statement of Interest Application Practicum (York University)

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Completed 10 April 2022

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