Hominy Public Schools - Certified Staff Application

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Certified Staff Application

Certified Staff Application

CERTIFIED STAFF
APPLICATION FOR INSTRUCTIONAL STAFF POSITION

All applicants for teaching, counseling or administration positions at Hominy Public Schools must complete this application. An application is incomplete unless accompanied by complete transcripts and a photocopy of an Oklahoma Certification.

Teaching Application

Reaquired field: Date:

Reaquired field: Name
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Reaquired field: Address
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Reaquired field: City
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Reaquired field: State
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Reaquired field: Zip
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Are you 18 years of age or older?

Yes

No

Are you related to anyone employed by or a board member of Hominy Public Schools?

Reaquired field: Yes

Reaquired field: No

Reaquired field: If yes, Please list the name and relation of all relatives who work for Hominy Public Schools.
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Are you legally eligible for employment in the United States? (Proof of eligibility will be required prior to employment.)

Reaquired field: Yes

Reaquired field: No

Home Phone Number
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Work Phone Number
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Reaquired field: Certification #
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Reaquired field: Expiration Date:

Position Applied For

Early Childhood K-2

Elementary Grades 1-3

Elementary Grades 4-5

High School Grades 9-12

Reaquired field: Subject(s)

Junior High Grades 6-8

Subject(s)

Administrator(Elementary)

Administrator(Secondary)

Counselor

Library-Media

Special Education

Other
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EVIDENCE OF PROFESSIONAL AND EDUCATIONAL LEADERSHIP

Professional Organizations

What Professional Journals have you read during the past year?

What Professional journals do you consider most helpful in your teaching field?

What Professional conferences or education association meetings have you attended in the last two school years?

AREAS OF CERTIFICATION (CHECK APPROPRIATE LINES)

1000 Elementary

1000 Early Childhood

1501 Elem. Education

2000 Elem./Sec. Education

2001 Art

2075 Art-Jr. High

2003 French

2005 German

2007 Latin

2011 Spanish

2080 Foreign Lang. Jr. High

2013 Music/Instr.

2014 Music Theory

2015 Music/Vocal

2085 Music Jr. High

2017 Health

2019 Physical Ed/Health

2090 Physical Ed. Jr. High

2021 Reading Specialist

2500 Special Education

2501 Emotionally Disturbed

2503 Hearing Impaired

2505 Learning Disability

2507 Mentally Handicap

Physically Handicap

2511 Visually Impaired

Secondary Education

3000 Agriculture

3001 Agriculture General

3500 Business

3501 Accounting

3503 Business English

3505 Business Law

3507 Business Machines

3509 Business Math

3511 Career/Occup. Infor.

3513 Comp In Bus/Info Pr.

3515 Economics

3517 Finance

3519 General Business

3521 Management

3523 Marketing

3525 Office Proc/Management

3527 Shorthand

3529 Typewriting

4000 Language Arts

4001 American Literature

4003 English Literature

4005 Grammar & Comp.

4007 Journalism

4009 Library Science

4011 Newspaper

4013 Speech & Drama

4015 World Literature

4017 Yearbook

4075 Lang. Arts Jr. High

4500 Home Economics

4501 Home Economics/Gen.

4503 Adult/Family Living

4505 Career Education

4507 Child Dev./Parent Ed.

4509 Consumer Education

4511 Nutrition Education

4513 Textiles/Clothing

5000 Industrial Arts

5001 Drafting Technology

5003 Electric/Electronics

5005 Gen. Industrial Arts

5007 Graphics

5009 Metal Technology

5011 Power Technology

5013 Wood Technology

5500 Mathematics

5501 Algebra

5503 Analysis

5505 Calculus

5507 Computer Sci/App.

5509 General Mathematics

5511 Geometry

5513 Linear algebra

5517 Trigonometry

5575 Math Jr. High

6000 Science

6001 Anatomy/Physiology

6003 Biology

6005 Botany

6006 Chemistry

6007 Computer Application

6009 Earth Science

6011 General Science

6013 Physical Science

6015 Physics

6017 Zoology

6075 Science Jr. High

6500 Social Studies

6501 American History

6503 Ancient/Med History

6505 African American History

6507 Conservation of Nat. Res.

6509 Democracy

6511 Economics

6513 Geography

6515 International Prob.

6517 Oklahoma History

6519 Sociology/Anthrop.

6521 U.S. Government

6523 World History

6575 Social Studies Jr. High

0500 Prof. School Services

501 Superintendent

0503 Secondary Principal

0505 Elementary Principal

0507 Vocational Administration

0509 Audio Visual Special

0511 Census and Attendance

0513 Librarian

0515 Library Media Specialist

0517 Psychologist

0519 Psychometrist

0521 Speech-Lan. Pathology

0523 Speech Pathologist

0525 School Counselor

0527 Teacher Counselor

0529 Visiting Counselor

7000 Specialized Services

7001 Occupational Therapy

7003 Physical Therapy

7005 School Nurse

7500 Industrial Arts

7501 DE/Marketing

7503 Occup. Agriculture

7505 Occup. Home Economics

7507 Technical Education

7509 Trade/Indus. Education

7511 Voc. Agriculture

7513 Voc. Business/Office

7515 Voc. Health Occup.

7517 Voc. Home Economics

8000 Special Endorcements

8001 Aeronautics

8003 Athletic Coaching

8005 Bilingual/Multicultural

8007 Computer Science

8009 Driver/Safety Ed.

8011 English Second Language

8013 Psychology

8015 ROTC

Type

1. Major

2. Minor

3. Cert. End.

4. Conv. End.

5. Spec. End.

Level

90 N-K

91 N-2

92 N-12

93 K-8

94 K-12

95 7-8 Endors.

96 7-12

9709-12

99 All

065 Class

P Professional

S Standard

A Prov. 1

B. Prov. II

C Prov. I-Voc.

D Prov. II-Voc.

E Emergency

L License

Degree

Doctorate

Ed. Specialist

Masters

Bachelors

Associate

Other

Other

References: List the name of four references capable of giving information about your teaching and preparation for teaching. List at least one administrator for each of your teaching positions.

Reaquired field: Full Name of Reference
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Reaquired field: Position
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Reaquired field: School Name and Address
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Reaquired field: Phone
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Reaquired field: Full Name of Reference
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Reaquired field: Position
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Reaquired field: School Name and Address
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Reaquired field: Phone
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Reaquired field: Full Name of Reference
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Reaquired field: Position
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Reaquired field: School Name and Address
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Reaquired field: Phone
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Reaquired field: Full Name of Reference
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Reaquired field: Position
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Reaquired field: School Name and Address
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Reaquired field: Phone
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Reaquired field: High School Attended
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Reaquired field: Mailing Address
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Reaquired field: Year Graduated:

Reaquired field: Year Graduated
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Reaquired field: College or University Attended
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Reaquired field: Dates of Attendance:

Reaquired field: Major Field of Study
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Reaquired field: Minor Field of Study
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Reaquired field: Type of Degree
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Reaquired field: Year Earned
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Student Teaching

Reaquired field: Date:

Reaquired field: Name of School
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Reaquired field: Address
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Extra Curricular Activities You Can Direct

Reaquired field: Yearbook

Reaquired field: Newspaper

Reaquired field: Cheerleading

Reaquired field: Coaching

Reaquired field: Other

Other

Teaching Experience: List in chronological order.

Reaquired field: From
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Reaquired field: To
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Reaquired field: Number of Years
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Reaquired field: Name and Address of School
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Reaquired field: Principal or Supervisor
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Reaquired field: Grade or Subject Taught
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From
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To
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Number of Years
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Name and Address of School
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Principal or Supervisor
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Grade or Subject Taught
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From
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To
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Number of Years
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Name and Address of School
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Principal or Supervisor
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Grade or Subject Taught
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From
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To
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Number of Years
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Name and Address of School
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Principal or Supervisor
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Grade or Subject Taught
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From
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To
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Number of Years
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Name and Address of School
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Principal or Supervisor
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Grade or Subject Taught
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Non-Teaching Experience: List in Chronological Order.

Reaquired field: From
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Reaquired field: To
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Reaquired field: Name of Employer
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Reaquired field: Address
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Reaquired field: Kind of Work
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From
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To
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Name of Employer
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Address
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Kind of Work
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From
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To
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Name of Employer
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Address
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Kind of Work
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Are you willing to accept any assignment for the good of the school system, attend meetings or participate in other activities outside of school hours or Saturday mornings?

Have you ever failed to be reemployed?

If yes, Where?
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Reaquired field: If yes, please explain
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Why do you wish to leave your present position?
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On what date will you be available if offered employment at School Name?
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Have you ever entered a plea of guilty or nolo contendre to a state (any state) or federal charge? (This question includes criminal cases involving a

Yes

No

Have you ever been charged with a state (any state) or federal felony offense, which was reduced to a misdemeanor offense to which you entered a plea of guilty or nolo contendere? (This question includes criminal cases involving a "deferred sentence," "deferred judgement" and any "expunge of the records.")

Yes

No

Have you ever entered into a deferred prosecution agreement with a state (any state) or federal prosecutor?

Yes

No

Have you ever been required to register as a sex offender under the Oklahoma Sex Offender Registration Act or under similar laws in another state?

Yes

No

Did you serve in the military?

yes

no

If yes, what branch of service?
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Date Entered
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Rank at Discharge
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Type of discharge or separation
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Date of discharge or separation
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Major Duties
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Service Schools Attended
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Reaquired field: Upload Resume

Upload

Reaquired field: Upload Cover Letter

Upload

I understand that my application will remain active for one year and that I should notify Hominy Public Schools, in writing, if I wish to be considered beyond that period. All persons, firms, and entities listed in this application are hereby authorized to release any information or records concerning me to the personnel department of Hominy Public Schools and I hereby release said persons, firms, and entities from any liability as a result of the furnishing of such records and information. I certify to the best of my knowledge the facts set forth in my application are accurate and complete. I understand that falsifying information on this application will result in non-employment or, after employment or discharge.

Reaquired field: Signature (By typing your name, you agree that this is valid as your signature.)
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Reaquired field: Date
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Email a copy to

optional

Required Fields

Hominy School District

200 S. Pettit Ave.
Hominy, Oklahoma 74035
Phone: 918-885-6511
Fax: 918-885-6369

Early Childhood Center: 918-885-6813
Elementary School: 918-885-6255
Middle School: 918-885-6253
High School: 918-885-2141
Administration: 918-885-6511

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Hominy School District

200 S. Pettit Ave.
Hominy, Oklahoma 74035
Phone: 918-885-6511
Fax: 918-885-6369

Log In

Early Childhood Center: 918-885-6813
Elementary School: 918-885-6255
Middle School: 918-885-6253
High School: 918-885-2141
Administration: 918-885-6511

Log In

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