Albert City-Truesdale Community School

Teacher Application Form

Equal Opportunity Employer
The Albert City-Truesdale Community School District extends equal opportunities to all employees, and to applicants for employment who meet the qualifications established for the class or position for which they apply. No employee or applicant shall be discriminated against on the basis of race, creed, color, sex, national origin, religion, age, or handicap. Preference will be given to veterans in accordance with IOWA CODE, CHAPTER 70, VETERANS PREFERENCE LAW.

PERSONAL

Name______________________________________________ Soc. Sec. No._______________________________

(Last) (First) (Middle)

Present Address:_______________________ Telephone: ( )__________________

City:__________________ State:_______________ Zip Code:____________________

Position for which you are applying: (circle) 1. Elementary 2. Junior/Senior High School 3. Extra Duty

With which extra-curricular activities can you help? Name order of preference:

________________________________________________________________________

Are you under contract for next year? __________ Where?________________________

Please give the name and address of the placement bureau where your credentials are on file:

_______________________________________________________________________

I have requested that my credentials be sent to Albert City-Truesdale (circle) Yes No

Community School

CERTIFICATION

Do you hold a current Iowa certificate? ___________ Expiration Date________

If so, List: Type of Certificate _______________ Grade level____________

Approvals/Endorsements (Include coaching)__________________________

If you do not hold an Iowa certificate, please contact the Bureau of Teacher Education and Certification, Iowa Department of Education, Grimes Office Building, Des Moines, Iowa 50319, regarding your eligibility for an Iowa certificate. Furnish information to our personnel office regarding your certification as soon as you receive pertinent information from the Bureau Chief. This district does not assume any responsibility for your certification. All contracts require a valid certificate before any salary can be paid.

School	Name of School	Location	Date of Graduation
High School
College and/or University


Graduate

College Major:_____________________________ College________________________

Graduate Emphasis_______________________________________

TEACHING EXPERIENCE

Dates	Name of School	Location	Reason For Leaving

MILITARY

Complete this section if you served in the U.S. Armed Forces

Describe your Duties and any Special Training________

______________________________________________

Branch of Service_________ Rank of Discharge________

Date of Discharge_________ Period of Active Duty_______________

REFERENCES

Name	Title or Position	Address	Phone
			( )
			( )
			( )

ADDITIONAL INFORMATION

Add any information which you believe will assist us in arriving at a true summary of your qualifications.

_______________________________________________________________________

General Information:

1. A personal interview is required before an applicant can be recommended for election.

2. If employed, the applicant agrees to accept the assignments to subjects and activities made by the superintendent and directors.

3. An approved teaching certificate and a current physical examination are required to validate a contract.

4. The applicant must provide complete and OFFICIAL transcripts of credit. Transcripts become the property of the District and will not be returned.

I hereby declare the information provided by me in this application for employment is true, correct, and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause for dismissal.

__________________ ____________________________

Date Signature of Applicant

Return To: Personnel Services

Albert City-Truesdale Community School

Box 98

Albert City, Iowa 50510