Catholic Schools of Fairbanks Immaculate Conception Elementary School Monroe Catholic Junior Senior High School 615 Monroe Street, Fairbanks, AK 99701 PHONE: 907.313.3291 FAX: 907.452.5978 Teacher Application Personal Data Work Full Name: ______________________________________________________________________________________________________________ Home address: ___________________________________________________ City, State Zip: ____________________________________ Home phone: ____________________________ Cell phone: ___________________________ Work phone: _____________________ (Which of the above phone numbers is the best number for reaching you? Check one: Home Cell Email address: ___ _________________ _________________ _____________ Eligible to work in the United States? ____________________ Religion: ____________________________________________________ Parish/Church: _________________________________________ Educational Background: Attach copies of transcripts from colleges and universities attended. Name of School City, State Dates attended Major / Minor Degree(s) earned Date granted High School College/ University/ Other Student Teaching: School: ________________________________________________________________ City, State: ____________________________________ Dates: ____________________________________ Grade Level(s): ________________________ Subject area(s) if relevant: ____________________________________________________________________________________________ Certification(s): Attach copies of certificates State/Agency: ________________________ Type: _________________ Date of Issue: ________________ Expiration: __________ State/Agency: ________________________ Type: _________________ Date of Issue: _____________ ___ Expiration: __________ State/Agency: ________________________ Type: _________________ Date of Issue: ________________ Expiration: __________ State/Agency: ________________________ Type: _________________ Date of Issue: ________________ Expiration : __________ List major workshops, seminars, internships, grants, or summer programs you have participated in over the last five years, which are not normally part of a degree program. Include program sponsor and dates. ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ List professional association memberships: ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ Present Educa tional Assignment and Extra -‐Curricular Involvement: School: _______________________________________________ Position: _______________________________________________________ Principal or School Director: ___________________________________________________ ___ Phone: __________________________ Address: _____________________________________________________________________________ Grades taught: _________________ Subject(s) taught (if departmentalized): _______________________________________________________ ______________________ Total number of students taught this year: ______________ Part time or Full time? ________________________________ Hire Date: __________________________________________ What extra-curricular activities are you involved with or do you feel qualified to lead? Please describe your experience. ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ Previous Educational Employment: L ist most recent first Name of School City, State Grade(s) or Subject(s) From Mo/Yr To Mo/Yr Other Experience : Include all full -‐time non -‐educational employment during the past fi ve years, whether or not it has been pertinent for a position in education. In addition, list other experiences, which, though not academic, have been of service in preparing you for a position in education. List the most recent first. Employer Address Position From Mo/Yr To Mo/Yr Professional/Personal References: Please list at least 3 references. You may also include letters of recommendation with y our application. Name Address Phone Numbers Relationship With this application, please submit a cover letter stating why you would like to teach in a Catholic school. Signature of applicant: _____________________________________________________________ Date submitted: _______________ -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ For Office Use Only: Date received by school : ______________________ Interview date: _____________________ Time: ____________________ Teaching certificate: ___________________________ Cover letter: ________________________ Fingerprinted: __________ Physical: _________________ _______________________ Willing to sub? _____________________
