CERTIFIED APPLICATION
AN APPLICATION FOR TEACHER	                                                ADMINISTRATIVE OFFICES
WALLACE SCHOOL DISTRICT #393                                                                                                                               VOICE (208) 753-4515
PO Box 267, Silverton, ID 83867	                     FAX    (208) 753-4151

AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER

Name_____________________________________________________________________________________________________
                                          (last)                                                              (first)                                                    (middle)

Permanent Address______________________________________________________________Phone________________________

PERSONAL DATA:

List those community activities or tasks in which you feel competent and interested in:

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________
List those school activities or tasks in which you feel competent and interested in:

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________
On a separate sheet of paper, please write an explanation, not to exceed 250 words, of your major strengths as they apply to the position for which you are making application.

CURRENT SCHOOL DISTRICT INFORMATION:

Are you presently under contract to a school district?______________________________________________________________

If yes, when does your current contract expire?____________________________________________________________________

Name of District______________________________________________________________________________________________

Position___________________________________________________________________________________________________

Do you hold or qualify for a  valid Idaho Teaching Certificate?___yes___no

Type of Certificate and Endorsements__________________________________________________________________________

Date Certificate was issued______________________________________

If you do not have a valid Idaho Certificate, do you have comparable out of state certification?  ___yes___no - State_______

Where are your credentials on file?_______________________________

EDUCATIONAL TRAINING:   (list in order of attendance)                                                        (Check to indicate class hours)
		                                             ___Semester          ___Quarter
        College or University                   Location                   Dates                      Degree Earned
                                                                                              Inclusive                          and                                     Major        Hours       Minor      Hours
                                                                                                                             Date of Degree

___________________________________________________________________________________________________________

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JOB RELATED EXPERIENCE:

         Name                                       Employer Location                         Superintendent             Number                  Date
                                                                                                                    or Supervisor              of Years           From        To                Position Held

____________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________

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REFERENCES:

         Name                                           Title                                                              Address                                                                 Telephone No.

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____________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________

Notice: Employment will be based on the following procedures:			4. Notification of Employment will be sent to the 
				candidate unless otherwise noted on vacancy listing.
				It is the candidates responsibility to check on 
1. Preliminary screening of applicants will be based on ability			employment status.  Notice of vacancy closings 
	to meet job description requirements as evidenced by			will be remitted to teacher placement centers
	completed application, placement file or transcripts and			and district postings only.
	three letters of recommendation.  Supportive job-related
	information not on this form may be submitted by the			I hereby certify that the information contained
	applicant.					herein is true and a complete record of my
						personal and professional record to date.

2. Additional data will be requested from the candidate or from			_____________________________________________
    a reference after step one, such as letters of recommendation			Signature of Applicant
   and other information as determined by the selection committee..
					_____________________________________________
3. Finalists will be required to attend a personal interview in the district.		Date