CERTIFIED JOB APPLICATION Minooka Community Consolidated School District #201 Online Application for Employment - Certified Personnel Please fill in the application and print it, then mail the application, copies (front and back) of teaching certificates, and copies of transcripts to: Dr. Stephen Palaniuk, Assistant Superintendent, Minooka CCSD #201, 304 Mondamin St. - Suite 116, Minooka, IL 60447.
PERSONAL DATA:
Last Name	First Name: MI
Social Security Number
Present Address:
Number and Street
City	State Zip
Permanent Address:
Number and Street
City	State Zip
Telephone(home)	Telephone(work)
Email address:
POSITION APPLIED FOR:	Check Grade Levels Preferred:
	K-2 3-4 5-6 7-8
	Subject Area 6-8: Add'l Subject Area: Add'l Subject Area:
CERTIFICATION:	Mail or fax a photocopy of teaching certificates, both front and back.
llinois Certification:	Yes: No Pending: Date Applied For: County
	TypeNumber TypeNumber TypeNumber
Honors and Awards:
EDUCATION:
Bachelor's Degree:	Major:
	Minor:
Advanced Degree:	Advanced Degree:
Major:	Major:
Advanced Degree:
Major:
	Names and Locations of Schools Attended (last school first)
College/University:	Dates attended:
Degree received:	Semester Hrs.: GPA:
College/University:	Dates attended:
Degree received:	Semester Hrs.: GPA:
College/University:	Dates attended:
Degree received:	Semester Hrs.: GPA:
CO-CURRICULAR ACTIVITIES:	Please indicate activities you can direct or sponsor
Music:	Dramatics: Publications: Clubs:
Sports: (please list)
Other: (please list)
	Are you willing to accept a co-curricular assignment each year you are employed in the district if the assignment is compensated in accordance with the negotiated agreement that is in effect? Yes No
PROFESSIONAL EDUCATION EXPERIENCE:	(Begin with most recent)
School Years:	City: State: Level Position:
Full Time:	Part Time:
School Years:	City: State: Level Position:
Full Time:`	Part Time:
School Years:	City: State: Level Position:
Full Time:	Part Time:
School Years:	City: State: Level Position:
Full Time:	Part Time:
School Years:	City: State: Level Position:
Full Time:	Part Time:
School Years:	City: State: Level Position:
Full Time:	Part Time:
STUDENT TEACHING EXPERIENCE:	Complete only if candidate has less than 3 years of teaching experience.
School:
Location:
Grades, Subj. Taught:
University Supervisor:	Business Phone:
Classroom Teacher:	Business Phone:
OTHER EMPLOYMENT EXPERIENCE:
1. Years (Dates):	Employer:
Address:	Position:
	Full Time: Part Time:
2. Years (Dates):	Employer:
Address:	Position:
	Full Time: Part Time:
3. Years (Dates):	Employer:
Address:	Position:
	Full Time: Part Time:
4. Years (Dates):	Employer:
Address:	Position:
	Full Time: Part Time:
5. Years (Dates):	Employer:
Address:	Position:
	Full Time: Part Time:
	During the past seven years, have you been convicted of a serious crime involving a person's life or property? Yes No
MILITARY SERVICE RECORD:	Branch of Service:
Date Entered:
Date Discharged:
Service-related Skills:
Community Activities:
Volunteer Activities:
REFERENCES:
Name:
Address:
Phone:
Name:
Address:
Phone:
Name:
Address:
Phone:
Name:
Address:
Phone:
	Please read carefully before submitting:
Please print and mail this application along with copies of transcripts of all college work and request your credentials be sent to Minooka Community Consolidated School District 201. If under contract elsewhere, you will be required to secure a satisfactory written release before receiving appointment here. After submitting the application, be sure to click the Reset Form button to clear your information from the form. By submitting this application, you certifiy that the facts set forth in this application for employment are true, accurate, and complete. You understand that any misrepresentations or omissions of facts made by you on this application shall be sufficient cause for your disqualification for employment or termination of employment. Furthermore, you understand that, pursuant of Section 22-6.5 of The School Code, 105 ILCS 5/22-6.5, your failure to provide requested employment or employer history which is material to your qualification for employment or the provision of statements which you do not believe to be true may be a Class A misdemeanor. You understand this application and records become the property of Minooka Community Consolidated School District 201. You hereby authorize Minooka Community Consolidated School District 201 to conduct work and reference checks to determine your acceptability. Minooka Community Consolidated School District #201 is an equal opportunity employer and does not discriminate on the basis of race, sex, color, national origin, ancestry, religion, age, physical or mental handicap or disability, marital status, military status, or unfavorable discharge from military service. This employer hires only individuals authorized to work under the Immigration Reform and Control Act of 1986.
Signature of applicant:
	Please mail copies (front and back) of teaching certificates, and copies of transcripts to: Dr. Stephen Palaniuk, Assistant Superintendent, Minooka CCSD #201, 305 Church St., Minooka, IL 60447.
	Please reset the application after printing or saving.
Reset Application: