City School District of Albany
Office of Human Resources | 1 Academy Park | Albany, NY 12207
(518) 475-6055 | humanresources@albany.k12.ny.us
Position applying for
Date available to start employment
Personal information
Please print.
Last name
First name
Middle initial
Present address
Permanent address (if different than address above)
Social Security number
Phone number
Are you eligible to work in the United States?
Please indicate any special accommodations required for you to perform the duties for this position applying for:
If you are a member of the NYS Teacher’s Retirement System, please list your number:
Certification information
Do you presently hold a valid New York State certificate for the position for which you are applying?
Certification area:
Type Date issued/expired Certification number
Professional /
Permanent /
Education and professional training
School name/location
Dates attended
Degree or diploma
Date of
High school
College (undergraduate)
College (graduate)
Other programs/sessions
What was your college major?
NOTE: Official transcripts will be required to verify salary schedule payment. However, for the purpose of evaluating your
candidacy, copies of the transcripts should be received with this application.
Educational experience
Please list your most recent experiences first.
Dates from/to
School name/location
Title, nature of work, subject, grade level
Total years
Please list other certificates you hold:
Student teaching
If fewer than three years of regular full-time employment, include student teaching experience here.
Dates from/to
School name/location
Subject or grade level
Supervising teacher
If presently employed, why do you wish to leave your current position?
Have you ever been dismissed from a position? If so, please explain.
Related professional experience
Lectures, publications, organizational membership, committee work etc.
Extracurricular activities
Are you qualified and willing to coach an athletic team or advise an extracurricular activity?
If so, please specify.
Prior tenure record
All applicants must complete and sign the statement in order to assure compliance with provisions of Section 3012, Subdivision 1, of
The Education Laws of the State of New York.
Have you ever been denied an appointment to tenure?
Have you ever received tenure in any school district or
Board of Cooperative Educational Services (BOCES)
anywhere in New York?
If yes, please indicate the following:
Tenure area
Name of district or BOCES in which granted
Tenure date
Applicant’s statement
Please give any additional information which you think might be helpful to us in evaluating your application, and state your reason for
seeking employment with the City School District of Albany.
I certify that the information contained in this application is true and correct to the best of my knowledge, and I understand that false or
incorrect information in this application is grounds for disqualification from further consideration or for subsequent dismissal from
employment if I am hired.
I also agree to notify the City School District of Albany of any material changes in the information provided on this application. I hereby
consent to have the City School District of Albany contact anyone it deems appropriate to investigate or verify any information I have
given or to discuss my background, past performance or suitability for employment.
Further, I hereby authorize my former employer(s), reference(s), and any other individual or organization to provide information solicited
by the City School District of Albany, and I hereby release and discharge each of the above, including the City School District of Albany,
from any liability of any kind or nature and waive all rights to bring any action for defamation, invasion of privacy or any similar course of
action against anyone contacted as a result of what he or she may say about me.
The Commissioner of Education is required by law and regulation to request a fingerprint-supported criminal history record from the
Division of Criminal Justice and the Federal Bureau of Investigation. Employment may be offered prior to receipt of finger print
clearance. Continued employment is contingent upon clearance from the State Education Department.
The following documents must be received in order your application to be processed:
1. Copy of NYS certification
2. Credential file/letter of recommendation
3. Copy of transcript(s); official transcript will be required if hired
4. Recent resume
5. Tenure letter (if applicable)
Applications may be returned to:
City School District of Albany
Office of Human Resources
1 Academy Park
Albany, NY 12207
(518) 475-6055
The City School District of the City of Albany, New York, does not discriminate on the basis of Age, Race, Color, National Origin, Sex,
Disability or Marital Status in Employment or any of the educational programs and activities which it offers or operates, as it is required
to do by Title VI of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act of
1973, the Age Discrimination Act of 1975, and the New York State Human Rights Laws.
Signature of applicant