San Lorenzo Valley Unified School District
325 Marion Avenue, Ben Lomond, CA 95005
Human Resources: (831) 336-5193
www.slvusd.org
Application for Certificated Employment/Certificated Voluntary Transfer Form
(In-House Probationary or Regular Employees Only)
This request may be submitted at any time whether or not a vacancy exists. The
transfer request shall remain in effect for two (2) years from the date of submission.
Human Resources Department: Approved Not Approved
Name: Date:
Last First M.I.
Contact Phone: Email:
Current Position: Current Site:
SLVUSD Hire Date:
Desired Position:
Reason for Request:
List Credentials and
Authorized Subjects:
Specialized Trainings/Certifications:
College Major: Minor (If Applicable):
Master’s Degree: Yes No Doctoral Degree: Yes No
Grade Levels/Subjects Taught:
I HEREBY CERTIFY that the information contained in the application is true and correct to the
best of my knowledge. I understand that any misrepresentations, falsifications, or material
omission of information on this application may result in my failure to receive an offer or, if I am
transferred, my being placed back into my original position or being placed into an unfilled open
position or being placed into an unfilled open position for which I am qualified.
Signature: Date:
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