SLV BOCES

JOB APPLICATION POOL

 

            Applicants understand that by completing this application form, they may be considered for position openings by any of the 14 school district members of the San Luis Valley BOCES or by the BOCES itself.  The enclosed/attached information will be shared with the member school districts at their request.

 

                        Send Applications to:

 

                                                Job Application Pool

                                                San Luis Valley BOCES

                                                2261 Enterprise Drive

                                                Alamosa, CO  81101

 

 

 

 

 

Position Desired: __________________________________  Date of Application: ___________

 

 

Name: ___________________________________________ Soc. Sec. # _______-_____-_____

 

Present Address: _______________________________________________________________

 

Permanent Address: _____________________________________________________________

 

Phone:   Day___________________  Evening ____________________

 

 

 

 

 

The San Luis Valley Board of Cooperative Services and its member school districts are

Equal Opportunity Employers.


 

PERSONAL DATA

 

Completion of this section is voluntary.

 

Date of Birth: _________________  Sex: _____________  Marital Status: _____________

 

Age:  _________  Ethnic  origin:  _______Black ______ Caucasian  __________ Am. Indian

                                                      ________Oriental  __________ Hispanic

 

 

EDUCATION

Name of School and location

Degree

Date

Major

Minor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPERIENCE

Inst/Company

& Address

Assignment

Start Date

End Date

Name & Phone of Immed. Super.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCES

Name

Position

Address

Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In your own handwriting, please write a paragraph or more on why you desire to work for the BOCES or one of the member school districts.  Attach a separate piece of paper if needed.

 

 

 

 

 

 

 

 

 

CERTIFICATES/LICENSES HELD

State

Type

Number

Expiration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you are not certified in Colorado, have you started the process? ________________________

Have you taken/passed the CAT? __________________________________________________

 

ENDORSEMENTS

 

            (  ) K-6              (  ) K-12                       (  )7-12             (  ) Other

            (  ) Sci              (  ) Read                       (  ) Hist             (  ) Math

            (  ) Eng             (  ) Art                           (  ) Soc. Stud.   (  ) Voc. Music

            (  ) G/T              (  ) Inst. Music              (  ) Lib               (  ) PE

            (  ) Sp/Drama   (  ) AH Ed.                  (  ) Business     (  ) Voc. Ed.

            (  ) Admin         (  ) Indust.                    (  ) Coun            (  ) H. Economics

            (  )  F Language ________________  (  ) Other _________________________

 

Endorsements cont.:

 

            (  )Special Education                             (  ) EMH                         (  )  EH

            (  ) Speech/Language                            (  ) School Psych          (  )  School Soc. Worker

            (  ) Vision                                                 (  )  Hearing Impaired   (  ) Audiology

            (  )  OT                                                      (  )  PT                            (  )  Other ___________

 

 

 

OTHER

Have you been convicted of a felony in the past ten years? ______________________________

If yes, please explain:____________________________________________________________

_____________________________________________________________________________

 

Have you received prior discipline or discharge for making threats, fighting or any incidents involving violence, harrassment or sexual misconduct in the workplace? (Such discipline or discharge is not an absolute bar to employment.) ______________________________________

If yes, please explain:____________________________________________________________

_____________________________________________________________________________

 

Have you received any citations for motor vehicle moving violations? _____________________

If yes, please explain:_____________________________________________________________________

_____________________________________________________________________________

 

 

ACKNOWLEDGMENTS, CONSENTS, AND REPRESENTATIONS TO OBTAIN

INFORMATION TO PROVIDE

 

1.      The applicant acknowledges that if employed, he or she will be an at-will employee.  That is, the employee or the employer may end the employment relationship with or without cause and with or without notice.

2.      The applicant consents for the employer to conduct reference checks and release of liability allowing the employer to contact former employers and references.

3.      The applicant affirms that all information provided is correct and complete and acknowledges that providing false or incomplete information may result in immediate termination, criminal prosecution, and/or loss of a teaching or other license.

 

 

_______________________________________________  ______________________________

Applicant's signature                                                                 Date