K-12 Online School - Karval, Colorado Online School K-12

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PERSONAL INFORMATION

First Name

Middle Name

Last Name

List any other names under which records may be received or listed.

Address

City

State

ZIP Code

Phone

E-Mail

Have you ever been convicted of or pleaded guilty to a felony?

Yes
No

If "yes", please explain fully

CERTIFICATION-EMPLOYMENT

Do you hold a valid Colorado Teaching Certificate?

Yes
No

If "no" are you eligible for a Colorado Teaching Certificate?

Yes
No

Do you now have a contract to teach in Colorado?

Yes
No

If yes, with whom?

EDUCATION

Give full record of your undergraduate and graduate educational and professional training. Post High School Degrees: Please list dates, majors and minors, institutions and graduation dates.

TEACHING EXPERIENCE

Begin with Most Recent: Please list dates, employers, assignments, supervisor's name and telephone number.

If not now teaching, give reason for discontinuing

Number of years of certified teaching experience: In Colorado

Number of years of certified teaching experience: Outside Colorado

OTHER WORK EXPERIENCE

Begin with Most Recent: Please list dates, employers, assignments, supervisor's name and telephone number.

REFERENCES

List any superintendents, supervisors, principals and fellow colleagues who are familiar with your professional work. Please list name, administrative position, school, address, and telephone number. If you have not been teaching for a period of time you may list personal references. Please list name, address, and telephone numbers.

SUBJECT AND GRADE PREFERENCE

1st Choice Grade Preference

1st Choice Subject Preference

2nd Choice Grade Preference

2nd Choice Subject Preference

Explain why you would like to be involved in an online program of this nature.

REFLECTIONS

What are your strengths?

What can your supervisor and students expect of you?

PLEASE READ CAREFULLY BEFORE SUBMITTING

I certify that the information given by me on this application and any supplement is true and correct to the best of my knowledge. I understand that false statements on this application and supplements may result in refusal or termination of employment.

Yes

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Karval School District RE-23
16232 County Road 29
Karval, CO 80823
Phone: (719) 446-5313
Toll Free: (866) 375-3404
Fax: (719) 446-5331

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