Employment Forms

APPLICATION FOR EMPLOYMENT
 
Return to:
Dohn Community High School
608 E. McMillan Street
Cincinnati, Ohio  45206-1926
 
AN EQUAL OPPORTUNITY EMPLOYER                                                                               Fax:  513-281-6103
 
Applicant are encouraged to submit a personal resume with this application to provide additional information regarding his/her qualifications for employment
 
PERSONAL DATA
 
Name __________________________________________________________________________
                      Last                                                                       First                                                  MI
 
Social Security No.    _____________________________
 
Other name(s) under which transcripts, certificates and former applications may be listed:
 
________________________________________________________________________________
                      Last                                                                      First                                                   MI
 
 
Address  ________________________________________________________________________
                                Street                                                                      City                            State                Zip 
 
Phone No. ________________________                    Cell Phone No.  ________________________
 
 
EMPLOYMENT DESIRED
 
____ Teacher      Certification Area  _____________________Certification Grades _______
 
____ Counselor     ____Teacher Aide       ____Clerical     ____Other _______________________
 
______Administrative  Certification Area ___________________Certification Grades ______ 
 
 
EDUCATIONAL DATA
 
Transcripts of all completed college or university coursework should accompany this application.  An official transcript (with University/College seal) will be required upon employment.
Name of School and Location
Date
Degrees Received
Semester Hrs. Earned
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                               
 
 
CERTIFICATION INFORMATION
(Teachers and Administration Only)
 
Ohio Certification
    
Type ___________________________Grades ________  Subject Field _____________________
 
Certificate Number ______________________  Issued Date_______  Expiration Date ________
 
If you do NOT hold a valid Ohio Certificate – Have you applied for one?  _________________
 
Date of Application _________________  Areas Applied For _____________________________
 
List any Out of State Certificates ___________________________________________________
 
Enclose a copy of your OHIO CERTIFICATE or other Certificates you hold with this application. 
 
MILITARY SERVICE RECORD
 
Service in the Armed Forces of the United States?      Yes ______   No ______
Dates served (Active Duty)
 
From  _____________ to _____________                     Branch of Service ____________________
 
Rank when separated from active service ___________________________________________
TEACHING EXPERIENCE
Start with present or most recent employer and list all teaching experience including student teaching.  Attach a second sheet if needed.
School Year
Beginning 
Month/Year
Ending
Month/Year
Name and Address of School
Subject/
Grade
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PROFESSIONAL REFERENCES
List names of professional educators capable of judging your teaching competence or potential.  Beginning teachers must include cooperating teacher and university supervisor for student teaching experience.  Experienced teachers must include administrators and supervisors for two most recent teaching assignments.
Full Name of Reference
Position
Complete Address – Street, City, Zip
Telephone
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NON-TEACHING WORK EXPERIENCE
Name of Employer
Complete Address – Street, City Zip
Dates
Type of Work
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PERSONAL STATEMENT
Use the space below to present in your handwriting a brief summary of why you chose teaching as a profession.
 
 
 
 
 
 
 
 
MEDICAL
Do you have any physical or mental disabilities that would prevent you from safely and substantially performing the job for which you are applying, or which would require accommodation?     Yes ______   No ______
 
Have you ever been convicted of any offence in Ohio, or in any other state, which includes one or more of the following: any felony, any sex offence, any offence of violence, any theft offence, or any drug offence?  Yes ______   No ______
 
A criminal record will not necessarily bar you from employment with Dohn Community High School, but an untruthful answer will.  Stated falsification or falsification by omission will be grounds for immediate dismissal.
 
Have you ever been disciplined, non-renewed, or terminated from a position of employment as a result of allegations of poor performance or wrong doing?  Have you ever resigned following threats of non-renewal or termination?  If so, please explain each such instance.
 
_______________________________________________________________________________
 
________________________________________________________________________________
 
Is there any reason why you cannot be highly punctual and regular in following any assigned work schedule?  Yes ______ No ______
This will authorize any hospital, doctor, physician or treating practitioner and any person, firm or corporation by whom I was previously employed to release any and all information concerning my health and/or previous employment to the Dohn Community High School Board of Trustees and its representatives.
I understand that I am required to have a criminal records check with BCI and/or FBI prior to employment.  I am also required to have proof of a negative reading on a TB test administered within the last 6 months, prior to employment.
In consideration of my employment, I agree to conform to the rules and regulations of Dohn Community High School.  I understand that the falsification of any information given or failure to state information is ground for immediate rejection or immediate dismissal.
Also, I swear or affirm that the facts set forth above in this application are true and complete.  Any material misrepresentation on this application or constitutes sufficient cause for rejection of the application, and for the termination at any time during the employment.
 
Applicant Signature _____________________________________Date __________
 
APPLICATIONS WILL BE KEPT ON FILE FOR A MINIMUM OF ONE CALENDAR YEAR.
 
 
Dohn Community High School affirms that no person shall, on the basis of sex, race, religion creed, color, national origin or handicap, be exclude from participation in, be denied the benefits of or be subjected to discrimination under any educational program or activity conducted under its auspices.  This shall extend to employees therein and to admission thereto.  Inquiries concerning the application of this policy may be referred to the superintendent or the designated coordinator.