Grant Parish School Board – Application for Professional Employment Grant Parish School System. An Equal Opportunity Employer. Δ Step 1 of 5 20% TO REMAIN ACTIVE, APPLICATION MUST BE RENEWED EACH TWELVE MONTHS BY WRITTEN REQUEST.PERSONAL DATAName(Required) Prefix First Last Suffix Current Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Permanent Address (if different) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneWork PhoneCell Phone(Required)Email Address(Required) PREVIOUS EMPLOYMENT WITH GPSBHave you previously worked for GPSB?(Required) YES NO If yes, what year?(Required)Under What Name?(Required)POSITIONS & SCHOOLS APPLIED FORSchools Applied For(Required) Georgetown High Grant High Grant Junior High Montgomery High Pollock Elementary South Grant Elementary Verda Elementary District / Central Office / Administration Select the school(s) or district-level location for which you are applying.Position(s) for which application is made:Elementary PreK-5 (Grade)Elementary PreK-5 (Subject)Middle School 6-8 (Grade)Middle School 6-8 (Subject)Secondary 9-12 (Grade)Secondary 9-12 (Subject)SPECIAL AREAS (Check all that apply) Special Ed. Gifted Talented Dyslexia Hearing Impaired Visually Impaired Adapted P.E. Homebound Diagnostician Licensed School Psychologist Occupational Therapist Social Worker Speech Therapy Nurse Math Intervention Reading Intervention Art Music Physical Education Vocational Librarian If Special Education, Area:(Required)If Vocational, Area:(Required)Coaching – Sports (Specify 1)Coaching – Sports (Specify 2)Coaching – Sports (Specify 3)Administrative Positions (Specify 1)Administrative Positions (Specify 2)Administrative Positions (Specify 3)Administrative Positions (Specify 4) EDUCATION/TRAININGCollege/University AttendanceCollege/UniversityDates Attended (From – To)Date of GraduationDegreeMajorGPAMinorMinor GPA Add RemoveCollege/University TranscriptsAccepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 10 MB. Submit a photocopy of transcripts of all college/university course work. (Originals will be required upon employment). Optional upload; you may also mail or deliver documentation if preferred.CERTIFICATIONType of Certificate held now:(Required) None Valid Permanent Louisiana Provisional, Professional or Administrative Louisiana Certification pending Valid Out of State If Valid Permanent Louisiana, Type:(Required)If LA Certification Pending, Explanation:(Required)If Out of State, Issuing State:(Required)Expiration Date:(Required) MM slash DD slash YYYY If you do not have a Louisiana Certificate, what are your deficiencies?Teaching CertificateAccepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 10 MB. A photocopy of the teaching certificate or letter verifying that certification requirements have been met must be submitted with this application. Optional upload; you may also mail or deliver documentation if preferred.AREAS OF CERTIFICATION Administration Middle School Special Education Secondary PreK-3 All Levels Elementary 1-5 Other Elementary Guidance Counselor Other Administration (specify):(Required)Administration (Number):(Required)Middle School (specify):(Required)Secondary (specify):(Required)All Levels (specify):(Required)Other Elementary (specify):(Required)Other Certification (specify):(Required)TEST SCORESPRAXIS: PPST ReadingPRAXIS: PPST WritingPRAXIS: PPST MathPRAXIS: Content AreaPRAXIS: Principles of Learning and TeachingNTE Scores: Communication SkillsNTE Scores: General KnowledgeNTE Scores: Professional KnowledgeNTE Scores: Specialty Area TEACHING POSITIONSPlease list below your last five teaching positions beginning with your current or most recent employer. Beginning teachers must list student teaching. This information must be completed. Only teaching full-time in an accredited public or private school or college is creditable. Creditable years will be verified and determined by the Louisiana State Department of Education.Teaching ExperienceFrom (Mo/Yr)To (Mo/Yr)# of YearsName and Mailing Address of SchoolGrade/SubjectSupervisor or Cooperating Teacher Add RemoveTotal Years listed aboveTotal Number of Creditable YearsREFERENCESList names of at least three references who can provide information about your teaching capabilities. Include a copy of your most recent evaluation.Professional ReferencesFull Name of ReferencePositionSchool DistrictAddressPhone Add RemoveMost Recent EvaluationAccepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 10 MB. Please upload a copy of your most recent evaluation. Optional upload; you may also mail or deliver documentation if preferred.OTHER WORK EXPERIENCEPlease list below all professional non-teaching positions held in the past five years.Non-Teaching ExperienceFrom (Mo/Yr)To (Mo/Yr)Name and Address of EmployerPositionPhone Number Add RemoveCOACHING / DIRECTINGCheck any of the following which you are able to direct or coach successfully: Basketball Football Softball Track Yearbook Cheerleaders Drill Team Playground Activities Band Choir Clubs Baseball Other GENERAL INFORMATIONAre you related to a member of the Grant Parish School Board or any other employee?(Required) YES NO Relation Details(Required)NameRelationshipDistrict Position Add RemoveWhy did you leave your last position, or why do you wish to leave your present position?(Required)BACKGROUND CHECKS**READ CAREFULLY** Background checks are done on all applicants/employees.Will any arrests or violations of the law be reported on the Criminal History Report?(Required) YES NO Have you ever been convicted of a felony offense, been found guilty or entered a plea of 'no contest'?(Required) YES NO If yes, please state where, when, and nature of offense.(Required)EMPLOYMENT DISCLOSURESHave you ever been terminated by a school system, resigned prior to the expiration of your contract, or asked to resign?(Required) YES NO If so, please provide an explanation identifying the employer, basis for termination or resignation, and the date of same.(Required)Have you ever been convicted, pled guilty, or no contest to a felony or other serious offense?(Required) YES NO If so, please provide an explanation identifying the charge, jurisdiction and court involved, date of conviction or plea, and factual basis of charge(s).(Required)Have you ever engaged in or been accused of engaging in sexual misconduct with a minor/student or the abuse or neglect of a minor?(Required) YES NO If so, please provide an explanation identifying the conduct or alleged conduct in question, including but not limited to the date(s), your employer at the time, criminal charges, jurisdiction and court involved, date of conviction or plea, and factual basis of the charge(s) or allegations.(Required)Have you been the subject of any investigation of alleged sexual misconduct involving a minor or student, abuse of a minor or student or neglect of a minor or student?(Required) YES NO If so, please provide an explanation identifying the conduct or alleged conduct in question, including but not limited to the date(s), your employer at the time, the results of the investigation, criminal charges, jurisdiction, court involved, date of conviction or plea, and factual basis of the charge(s) or allegations.(Required) NOTICE TO APPLICANTSBefore an application may be considered complete, the following documents must be filed with the Grant Parish School Board: (1) Completed application, (2) Photocopy of teacher certificate, (3) Photocopy of transcript of all college/university course work, (4) Teacher service record (if applicable)*, (5) Completed Criminal History Release Form, (6) Test Scores (Praxis or NTE), (7) Most recent evaluation.This application and the documents submitted herewith shall become the property of the school board… Interviews will be scheduled only when vacancies do exist… *In order to receive credit for prior years of service, it is the responsibility of each applicant to obtain service records for each school where previously employed.Application Certification(Required) I hereby certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that falsification of this record will be considered sufficient cause for disqualification or, if employed, dismissal. Further, I authorize the Grant Parish School Board to contact the references listed herewith and to obtain any record of criminal history in accordance with the Louisiana code. EMPLOYMENT DISCLOSURES ACKNOWLEDGEMENTDisclosure Certification(Required) I have read, understand and acknowledge the foregoing notice, conditions and directions for completing this application. I certify that the information provided herein and in the attachments hereto is accurate, true and complete to the best of my knowledge. I further certify that I have not been convicted, pled guilty or pled no contest to a felony or other serious offence, and have not engaged in physical or sexual misconduct, neglect or abuse with or toward a student. I hereby waive my confidentiality with regard to my work record or criminal record and consent to and authorize the release of information… I release anyone responding to such inquiry from any liability for providing such information. AUTHORIZATION AND RELEASE (Statutes 17:3884, 17:15, 17:81.9)IMPORTANT: READ CAREFULLY. Louisiana Revised Statutes 17:3884 provides that a school board considering the employment application of a person who has been evaluated in another school system shall request such person’s evaluation results… Louisiana Revised Statutes 17:15 also requires all applicants for employment to be fingerprinted… Louisiana Revised Statutes 17:81.9 further requires a school board receiving an application to request that all current and prior school board employers… provide it with all information in their records relative to instances of sexual misconduct…Final Authorization Certification(Required) I certify that the information which I have provided in the attached application is true and complete. I understand that furnishing false information or omitting information… could disqualify me… I hereby authorize the Grant Parish School Board to request, receive, and review my prior evaluations and information relative to sexual misconduct with students (if any)… I further release the Grant Parish School Board and all current and former employers… from any liability connected with such disclosures and do hereby specifically authorize such employer(s) to release to the Grant Parish School Board such information… Digital Signature (Full Name)(Required)Date(Required) MM slash DD slash YYYY
