Application for Instructional
Or Administrative Staff Position
COMMUNITY UNIT SCHOOL DISTRICT NO. 1
410 W. Polk
Charleston, Illinois 61920
www.charleston.k12.il.us

OFFICE USE ONLY

DATE RECEIVED
*  *


  ____ Official Transcript

  ____ Teaching Certificate (Front/Back)
 


Hand Written or Electronically Submitted

 

Name 

 
Last
 
First
 
Middle
 

Present Address 

 
    Street
 
  City
 
  State
 
  Zip Code
 
Telephone 

 
Area Code

 
Number

 

Permanent Address 

 
  Street
 
  City
 
  State
 
  Zip Code
 

Telephone

 
Area Code
 
Number
 
E-Mail Address  
 
Applying for position of 

Indicate grade(s) or secondary school subject(s) in order of preference.

 
Check appropriate space(s)

I am interested in: 

Full-time Part-time Substituting
 
General Information
Do you hold an Illinois
Teaching Certificate
Yes    No
Certificate Number

Classification Certificate

Is Certificate registration with the
Regional Superintendent of Schools?
Yes    No
If you do not hold an Illinois
certificate, have you applied
for one?    Yes    No
 
Why do you wish to teach in Community Unit School District No. 1?

AN EQUAL OPPORTUNITY EMPLOYER

 


 

Complete information ONLY for Teaching Position Preferred
Level(s) you are applying for
Elementary                   (Indicate preference by checking one box.)
Minor Area or Area of Specialization with Elementary Major:    Early Childhood (Pre K)    Primary (K-3)    Intermediate (4-6)
Number of Semester Hours in Reading Methods: 
Number of Semester Hours in Special Education: 
Middle School: Grades 7 and 8      (Indicate total semester hours of preparation for each subject preference.)
Subject Preference Semester
Hours
  Major Field Number of Hours
  Major Field Number of Hours
  What course have you had in adolescent psychology or in the
  understanding of the middle school age youth?

Indicate what you believe is the most important task to be accomplished by the school for the middle school age group.


What experience have you had working with this age level?

High School: Grades 9, 10, 11 and 12   (Indicate total semester hours of preparation for each subject preference.)
Subject Preference Semester
Hours
  Major Field Number of Hours
  Major Field Number of Hours
  What course have you had in adolescent psychology or in the
  understanding of the high school age youth?

Indicate what you believe is the most important task to be accomplished by the school for the high school age group.

What experience have you had working with this age level?

 


 

Education
Level School Attended City, State Degree Major Minor Dates (MM/YYYY)
From To
High School
University
University
Graduate
Graduate
 

Student Teaching

City, State Graduate or subject(s) taught Dates (MM/YYYY) Grade Received
From To
 
(Begin with most recent)

Teaching or Administrative Experience

Name of School City, State Position No. Years Taught Dates (MM/YYYY)
From To
  Name of Supervisor   

  Why did you leave? 

 
Name of School City, State Position No. Years Taught Dates (MM/YYYY)
From To
  Name of Supervisor  

  Why did you leave? 

 
Name of School City, State Position No. Years Taught Dates (MM/YYYY)
From To
  Name of Supervisor 

  Why did you leave? 

 
Name of School City, State Position No. Years Taught Dates (MM/YYYY)
From To
  Name of Supervisor 

  Why did you leave? 

 
 

Extra Curricular Activities

List extra curricular activities that you are interested in coaching below.

Interest 1                                                Interest 2

Interest 3                                                Interest 4

 

 
(Begin with most recent)

Work Experience Other Than Teaching

Firm, Institution, etc. Nature of Work Date (MM/YYYY)
From To

 


 

Optional Personal Information
 
Please supply a resume or any personal information below which you judge to be pertinent to this application.

 

Please state succinctly several teaching or administrative goals and objectives that you would utilize in the position for
which you are applying.
 
Please Note: You should request that an official transcript and a copy of you confidential credentials
be sent by your university placement center to the Personnel Department for Community Unit School
District No. 1.
 
Address communications to: Superintendent of Schools
Charleston Community Unit School District No. 1
410 W. Polk
Charleston, Illinois 61920
Telephone: (217) 639-1017
 

Please Read and Sign

I hereby certify that the statements above are true and complete to the best of my knowledge. If any of the foregoing information is untrue in any respect I understand that such statement shall be grounds for termination of my contract with
Charleston School District. I also understand that before any contract for teaching becomes effective or compensation is
possible, a valid Illinois Teachers Certificate for the teaching assignment must be filed in the office of the Superintendent of
the Education Service Region of Coles County.

By signing this application I authorize Charleston School District No. 1 to request information from any of
my former employers with respect to my work performance for such employers, and I authorize each of my former
employers to provide said Charleston Community Schools with all information, including a written reference, as requested by
the Charleston Public School. I further understand that if I accept a contract to teach in Charleston School District No. 1, the above factual statements are to become a part of my permanent record.

 

Date

(This will be automatically enter upon submission)

  Signature of Applicant

 


 

Charleston Community Unit School District No. 1
Equal Employment / Affirmative Action Information Request

 
Community Unit School District No. 1 is required by Federal Law to request and maintain data on the racial/ethnic and gender identity and handicap/veteran status of all applicants for employment.  This data will provide the Charleston School District and the Federal Government with information necessary to monitor the Charleston School District's compliance with Equal Employment opportunity requirements.
 
Please complete this form.  Submission of the information requested is voluntary and failure to provide it will not subject you to and adverse treatment.
 
NAME:  DATE:  (This will be automatically enter upon submission)
POSITION APPLIED FOR: 
HOW DID YOU LEARN OF THE OPENING FOR THIS POSITION?

SEX:

  MALE    FEMALE 
RACIAL/ETHNIC DATA:
 
 WHITE  (not of Hispanic origin)  Persons having origins in any of the original peoples of Europe, North Africa or the
    Middle East.
 BLACK  (not of Hispanic origin)  Persons having origins in any of the black racial groups of Africa.
 HISPANIC  Persons of Mexican, Puerto Rican, Cuban, Central and South American or Spanish Culture or origin
    regardless of race.
 AMERICAN INDIAN OR ALASKAN NATIVE  Persons having origins in any of the original peoples of North
    America, and who maintain culture identification through tribal affiliation or community recognition.
 ASIAN OR PACIFIC ISLANDER  Persons having origins in any of the original peoples of the Far East, Southeast
    Asia, the Indian Subcontinent, or the Pacific Islands.  This area includes, for example:  China, Japan, Korea, the
    Philippine Islands and Samoa.
 
HANDICAP AND VETERAN STATUS:
 
 HANDICAP  "Handicapped person" means any individual who has a physical or mental impairment which substantially
    limits one or more major life activities, has a record of, or is regarded as having such an impairment.
 SPECIAL DISABLED VETERAN  Any veteran who (a) is entitled to compensation by the veteran's Administration
    for a disability rated to 30 percent or more, or (b) was discharged or released from active duty by reason of service
    connected disability.
 VIETNAM ERA VETERAN  Any veteran of the armed services who served on active duty for at least 181 days, any
    part of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released therefore with
    other than a dishonorable discharge, or (b) was released from active duty for a service-connected disability if any part
    of such active duty was performed between August 5, 1964 and May 7, 1975.