Dear Applicant:

Thank you for your interest in a licensed position in Liberty School District J-4.  The following instructions outline the application procedures and the conditions under which you might be employed by Liberty School District.  Please read carefully.

In order to be considered for a position with Liberty School District, your application must include all of the following:

¾      A letter requesting consideration for the specific employment position.

¾      The completed district application form and a Notarized Applicant’s Oath (The Applicant’s Oath may be completed during the interview process).

¾      A photocopy of your current Colorado teaching certificate/license.  If you do not have a Colorado certificate/license, please contact the Colorado Department of Education, State Office Building, 201 E. Colfax, Denver, Colorado 80203, (303) 866-6628 concerning licensing.

¾      College placement credentials or three letters of recommendation from recent administrators or employers.

¾      Transcripts of all undergraduate and graduate course work.  (Unofficial copies are acceptable for application; however, official transcripts are required if employed.)

¾      Current resume.

Your application will be reviewed when all required documents have been received.  Incomplete applications will be purged within 45 days, or when position is filled.  Applications for employment are updated yearly.  If you wish your application to be kept on file after October 1, it will be your responsibility to notify us each year prior to October 1.  If no response is received, your file will be closed.

A personal interview is required for employment.  If you are being considered for a vacancy, the Principal/Supervisor will contact you to schedule an appointment.

Should you experience a change of name, address, or telephone number after you have submitted your application, please notify Liberty School District in writing.

Applicant’s Note: This application form is intended for use in evaluating your suitability for employment.  It is not an employment contract.  Please answer all appropriate questions completely and to the best of your ability.   False or misleading statements are grounds for refusal or termination of employment and benefits.  All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin or the presence of disabilities.  A felony conviction will not necessarily bar an applicant from employment.  To assure qualification for essential functions of the job, employment may be contingent upon the results of additional testing of your job-related skills, mental/physical abilities, physical condition, and for the presence of drugs in your body.

Applicant Instructions

1.       Please read “Applicant’s Note”.

2.       Return form to: 

 

Liberty School District J-4
9332 Highway 36

P.O. Box 112
Joes, CO  80822.

3.       Complete all pages of the following form.

4.       If additional space is required, please use the “General Comments” page located at the end of this application.

5.       The Affirmative Action Questionnaire is optional.  This information is gathered for affirmative action under Section 503 of the Rehabilitation Act of 1973.  The information requested is voluntary and will be kept confidential.  An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire.

Dave Eastin

Superintendent/Principal

Liberty School District J-4

           Joes, Colorado

Teaching Position Preference(s)                                  

Date you are available:                                             

 FORMCHECKBOX  Check if you would like to be placed on our
     substitute list.

Application for Professional/Teaching Position

Your application will not be considered unless every question in this section is answered.  Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical.  If space is not adequate to list all past employment, continue on separate sheet.

Employment or Education Comments:                                                                                                          

General Information

1.        If presently employed, why do you wish to change?

____________________________________________________________________________________________________

2.        Are you presently under contract?

                 FORMCHECKBOX  Yes            FORMCHECKBOX  No

                If yes, where? _____________________________ Present Position __________________________________________

 

                Contract type?

 FORMCHECKBOX  Annual/Probationary             FORMCHECKBOX  Continuing/Tenure        FORMCHECKBOX  Other (explain below)

____________________________________________________________________________________________________

                Can you be released from your contract if you are offered a position?

 FORMCHECKBOX  Yes   FORMCHECKBOX  No

3.        If not currently under contract, have you ever held a continuing contract?

 FORMCHECKBOX  Yes   FORMCHECKBOX  No              

                If yes, cite school district(s), date(s) and state.

                ____________________________________________________________________________________________________

                Have you ever been refused tenure or a continuing contract?

                 FORMCHECKBOX  Yes   FORMCHECKBOX  No

                If yes, comment under General Comments.

4.        Have you ever been discharged or requested to resign from a position?

 FORMCHECKBOX  Yes   FORMCHECKBOX  No

                If yes, comment under General Comments.

5.        Have you ever had a certificate or license revoked or suspended?

 FORMCHECKBOX  Yes   FORMCHECKBOX  No

                If yes, comment under General Comments.

Legal Information

1)       Are you prevented from lawfully becoming employed in this country because of VISA or immigration status? (Proof of citizenship or immigration status will be required upon employment.)

 FORMCHECKBOX  Yes   FORMCHECKBOX  No

2)       Have you been dismissed from any position for any immoral or unprofessional conduct or unfitness for services?

 FORMCHECKBOX  Yes   FORMCHECKBOX  No

3)       Have you since the age of 18, ever been convicted of a misdemeanor or felony?

 FORMCHECKBOX  Yes   FORMCHECKBOX  No

Note: A conviction will not necessarily bar you from employment.  Each conviction will be judged on its own merits with respect to time, circumstances, and seriousness.  If any of the above statements have been answered yes, explain under General Comments.

Referral Source:

 FORMCHECKBOX  Advertisement/Posting                FORMCHECKBOX  Employee/Friend           FORMCHECKBOX  Internet          FORMCHECKBOX  Other (explain below)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

I have read and understand the procedures and conditions of employment in Liberty School District J-4.

I understand that Liberty School District J-4 may conduct examinations into my background; I understand that reference checks will be made; I understand by affixing my signature below that I consent to such examination; I further understand that my signature certifies that all information in this application is true and correct; I understand that false statements on this application may result in termination of employment.

In the event that Liberty School District J-4 employs me, I agree to abide by all its applicable policies, procedures, rules, and regulations.

Certification and Release

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief.  I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment.  I authorize Liberty School District J-4 and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records.  I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information.  I also understand that the use of illegal drugs is prohibited during employment.  If Liberty School District J-4 policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

Signature                                                                                              Date

Thank you for applying to Liberty School District J-4.  Our goal is to find the most qualified staff in order to prepare our students to meet the challenges of their own futures.

Liberty School District J-4

9332 Highway 36

P.O. Box 112

Joes, CO  80822

(970) 358-4288

Fax:  (970) 358-4282

Liberty School District J-4

Permission for Possible Future Release of Application Information

Occasionally, other Colorado public school districts inquiring about applicant information when the districts are trying to fill a position vacancy will contact us.  In an effort to cooperate, we would like to provide information about high quality applicants that were not selected for one of our positions.  We cannot release such information without the applicant’s approval.

Please check below your wishes in this matter:

 FORMCHECKBOX         DO NOT release any of my application information to another school district.

 FORMCHECKBOX         Release only my name and telephone number to another school district.

 FORMCHECKBOX         I approve of the release of any and all information in my application file to proper authorized administrator(s) in other requesting Colorado public school district(s).

______________________________________________________             ___________________________

                                        (Signature)                                                                       (Date)

For Office Use Only

1)                   School District Sent To:                                                                        Date:                                      

Documents Sent:                                                                                                                                 

2)                   School District Sent To:                                                                        Date:                                      

Documents Sent:                                                                                                                                 

Liberty School District J-4

9332 Highway 36, P.O. Box 112

Joes, CO  80822

Pre-employment Verification

Classified/Certificated Employees

Applicant’s Oath

(Colorado Revised Statute 22-32-130)

Name (Last, First, Middle, Maiden) ______________________________________________________________________________

Social Security Number___________________    I have applied for the ___________________________________  position

I am the above listed applicant and I do hereby certify under penalty of perjury, either:

1.              FORMCHECKBOX  I HAVE NEVER BEEN convicted of committing a felony* or misdemeanor* (other than a misdemeanor traffic offense or traffic infraction).

2.              FORMCHECKBOX  I HAVE BEEN convicted** of committing a felony or misdemeanor (not including a misdemeanor traffic infraction).  Information specifying a felony or misdemeanor for which I was convicted is as follows:

Convictions(s)____________________________________________________________________________________________

Court(s)__________________________________________________________________________________________________

Date(s)___________________________________________________________________________________________________

* A person is deemed to have been convicted of committing a felony or misdemeanor if such a person has been convicted under the laws of any other state, the United States, or any territory subject to the jurisdiction of the United States of an unlawful act, which, if committed within this state, would be a felony or misdemeanor.

** “Convicted” means a conviction by a jury or by a Court and shall also include the forfeiture of any bail, bond, or other security deposited to secure appearance by person charged with having committed a felony or misdemeanor, the payment of a fine, a plea of nolo contendere, and the imposition of a deferred or suspended sentence by the Court.

I hereby affirm that all information on and with this oath is true and complete.  I understand that any misrepresentation of facts may result in my termination and that falsification of statements on and with this attestation may be punishable by law.

                                Signature of Applicant                                                                                                      Date

                (To be signed in the presence of a notary public)

SUBSCRIBED AND SWORN TO BEFORE ME THIS             DAY OF,                                               20         

WITNESS MY HAND AND OFFICIAL SEAL.

                                                                                                                                MY COMMISSION EXPIRES                                        

                                Notary

                                                                                                                                SEAL

                                Address

VOLUNTARY Equal Employment Opportunity Information

Dear Applicant:

In order to comply with the Department of Education’s request for information for the Office of Civil Rights, please complete the following information.  This information is to be used for statistical purposes only and will be retained separately from the application.

Name_____________________________________________________________ Social Security Number ____________________

Address__________________________________________________________ Telephone Number ________________________

City_____________________________________________________ State______________ Zip Code _________________________

Date of Birth __________________________________

Position Applied for: __________________________________________________________________________________________

1.       Sex:

 FORMCHECKBOX  Male                                FORMCHECKBOX  Female

2.       Veteran/U.S. Military Status:

 FORMCHECKBOX  Non-veteran

 FORMCHECKBOX  Pre-Vietnam Veteran

 FORMCHECKBOX  Pre-Vietnam with service incurred disability

 FORMCHECKBOX  Vietnam Era Veteran (8/5/64 – 5/7/75)

 FORMCHECKBOX  Vietnam Era Veteran with service incurred disability

 FORMCHECKBOX  Post Vietnam Era Veteran

 FORMCHECKBOX  Post Vietnam Era Veteran with service incurred disability

3.       Ethnic Background:

 FORMCHECKBOX  White-origins in Europe, North Africa, or Middle East

 FORMCHECKBOX  Asian-origins in Far East, S.E. Asia, India or Pacific Islands

 FORMCHECKBOX  Black-origins in Africa

 FORMCHECKBOX  Hispanic-Mexican, Puerto Rican, Cuban, Central or South America

 FORMCHECKBOX  American Indian-origins in North America, to include Alaska

4.       Physical Condition:

 FORMCHECKBOX  No Handicap

 FORMCHECKBOX  Physically Handicapped (No Facility Modifications needed)

 FORMCHECKBOX  Physically Handicapped (Facility Modifications needed)

 FORMCHECKBOX  Health Handicapped (Heart Attack, Diabetic, Seizures, etc.)

 FORMCHECKBOX  Mentally Handicapped (Learning Disabled)

5.       Highest Degree of Education:

 FORMCHECKBOX  GED

 FORMCHECKBOX  High School Diploma

 FORMCHECKBOX  Associate Degree

 FORMCHECKBOX  Bachelor’s Degree

 FORMCHECKBOX  Master’s Degree

 FORMCHECKBOX  Specialist

 FORMCHECKBOX  Ed. D.

 FORMCHECKBOX  Ph. D.

Majoring area of highest degree: __________________________________________________________________________  

Liberty School District J-4

9332 Highway 36

Joes, CO  80822

AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER