USD 309 South Hutchinson

U.S.D. 309 does not discriminate on the basis of sex, race, color, national origin, handicap or age in admission or access to, or treatment, or employment in its programs or activities. Any questions regarding U.S.D. 309’s compliance with Title VI, Title IX, or Section 504 including information about the existence and location of services, activities, and facilities that are accessible to and useable by disabled persons may be directed to the Business Manager, who can be reached at (620)663-7141, 4501 W. Fourth St., Hutchinson, KS 67501, or to the Superintendent of U.S.D. 309.

First Name

Middle Initial

Last Name

Present Address:

City State Zip

Permanent Address:

City State Zip

Telephone:

Application for position of:

Position 1:

Position 2:

Position 3:

Position 4:

Date Available:

Educational Background:

High School Name:

Location:

Dates Attended:

Diploma Date:

Junior College Name:

Location:

Dates Attended:

Diploma Date:

Bachelor's College Name:

Location:

Dates Attended:

Diploma Date:

Master's College Name:

Location:

Dates Attended:

Diploma Date:

Ed.S. College Name:

Location:

Dates Attended:

Diploma Date:

Ph.D. College Name:

Location:

Dates Attended:

Diploma Date:

Hours taken since last degree:

Graduate Hours:

Undergraduate Hours:

High School Honors:

College Honors:

Have you ever been convicted of a felony or a crime involving dishonesty, a controlled substance, or a child? YesNo

Have you ever had a teacher or school administrator certificate denied, suspended, or revoked in any state? YesNo

Supplemental Assignments

Please check the potential supplemental assignments that might be of interest to you.

HS Pep Club

HS Debate Team

HS Play

HS Wrestling

HS Football

HS Volleyball

HS Track

HS Golf

HS Tennis

HS Basketball

HS Athletic Director

HS Baseball

HS Forensics

HS Soccer

JH Basketball

Class Sponsor

JH Wrestling

Cheerleader Sponsor

JH Soccer

Yearbook

JH Track

JH Volleyball

Intramurals

JH Pep Club

JH Football

Professional Data:

Current Employer:

Date in which you fulfill contractual obligations if currently employed by a school district.

Do you have a current Kansas Teaching Certificate? YesNo

List all endorsements:

Dates of expiration:

Teaching Experience
(List latest job first)

Job Date:

Location:

Position Held:

Reason for Leaving:

Job Date:

Location:

Position Held:

Reason for Leaving:

Job Date:

Location:

Position Held:

Reason for Leaving:

Job Date:

Location:

Position Held:

Reason for Leaving:

Professional References

Name:

Position:

Address:

Telephone:

Name:

Position:

Address:

Telephone:

Name:

Position:

Address:

Telephone:

Professional Opinions

Please write a course/grade level outcome reflecting a format that you feel represents the essential components of a measurable outcome.

Please describe the strengths that you have to offer for the position for which you are applying.

How can your administrator contribute to your success as a classroom teacher?

Please react to the statement that extracurricular activities make up the other half of a student’s education.

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