Teacher Application Blank
Barnwell School District No. 45
660 Hagood Avenue
Barnwell, South Carolina 29812
(803)541-1301
Date:__________________

FULL NAME:___________________________________________________________________________________________

HOME ADDRESS:_______________________________________________________________________________________

MAILING ADDRESS:_____________________________________________________________________________________

Please list telephone number(s) where you can be reached:

HOME (__ __ __)__ __ __ - __ __ __ __ Other (__ __ __ )__ __ __ - __ __ __ __

SOCIAL SECURITY NUMBER: __ __ __ - __ __ __ - __ __ __ __   DRIVERS LICENSE NUMBER:__ __ __ __ __ __ __ __ __

DATE OF BIRTH: __ __ / __ __ / __ __ __ __  PLACE OF BIRTH:__________________________________________________

SINGLE:_______________MARRIED:_________________WIDOWED:______________DIVORCED:_____________________

SPOUSE'S OCCUPATION:_______________NUMBER OF CHILDREN:__________CONDITION OF YOUR HEALTH:______

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEANOR: YES_____ NO_____ IF YES, PLEASE GIVE DATES

AND EXPLAIN: ___________________________________________________________________________________________.

IF BEGINNING TEACHER , PLEASE INDICATE:

PKE SCORE:_____________________ SUBJECT AREA AND SCORE ________________________________________________

TYPE SOUTH CAROLINA CERTIFICATE NOW HELD:____________________________________________________________

CLASS:__________________________________________ EXPIRATION DATE _________________________________________

AREA(S) OF CERTIFICATION: _________________________________________________________________________________

SUBJECTS OR GRADES YOU PREFER TO TEACH: ________________________________________________________________

OUT-STATE CERTIFICATES HELD: _____________________________________________________________________________

PLEASE LIST ALL FRATERNITIES, SORORITIES, AND OTHER ORGANIZATIONS OF WHICH YOU ARE A MEMBER:______

____________________________________________________________________________________________________________

 

YEARS OF TEACHING EXPERIENCE__________IF "0" PLEASE LIST SUPERVISORY

TEACHER AS REFERENCES ON THE REVERSE SIDE.

 

MILITARY SERVICE (ACTIVE DUTY ONLY)

BRANCH: ________________________________________________ DATES: ___________________________________________

TYPE OF DISCHARGE: ________________________________________________________________________________________

 

PLEASE ATTACH A COPY OF YOUR RECENT TEACHING CERTIFICATE.

 

EDUCATION: WHERE WHEN DATE OF GRADUATION DEGREE
HIGH SCHOOL   FROM:

TO:

    
COLLEGE   FROM:

TO:

    
GRADUATE SCHOOL   FROM:

TO:

    
SUMMER SCHOOL OR EXTENSION COURSES   FROM:

TO:

    

 

 

 

 

 

EXPERIENCE: GIVE COMPLETE HISTORY SINCE GRADUATION. (If you did not teach or work anywhere, or if you worked in a field other then education, please include that information.

Name of school (Latest first)

City and State

Grades taught

Subjects taught

Dates of Employment
1.       From:

To:
2.       From:

To:
3.       From:

To:
4.       From:

To:
5.       From:

To:

 

REFERENCES: Please include the last superintendent and principal with whom you were employed:

Name Position Address
1.    
2.    
3.    

 

Any remarks you consider pertinent or of value to this office may be written here.

 

 

We Are An Equal Opportunity Employer