Springfield Public Schools Intranet

Springfield Public Schools Intranet * Required Fields

*Last Name:

*First Name:

Middle Init:

Address:

*House #	Partial	Letter	Direction	*Street	Lot	Apt.

*City:

*State:

*Zip:

*Social Security #:

*Phone XXX-XXXX:

Area()

*Birth Date:

*Place of Birth (City, State):

Email:

Emergency Contact:

Relationship:

Phone: Area()

Position(s) for which you are applying: *

Administrative / Professional	Parent Educator
Clerical	Secondary Teacher
Coach	Security
Custodial	Special Education Attendant
Elementary Teacher	Special Education Teacher
Food Service	Teacher Assistant *
L P N Healthclerk

If applying for a specific position, please indicate:

* These positions require 60 semester hours of college credit.

This section is ONLY for teachers.

Type of teaching Certificate held: (Type 03, Type 09, Type 10, Type 75, Etc.)
Endorsements or Approvals: (Math, Science, Social Studies, Etc.)

Illinois Certificate: Yes- No- Pending- If you have an Out of State Certificate, choose the state:
Certificate #:

You must submit a copy of your transcripts for our files.

Education: High School(s) and College(s) Attended & Training*:

Name of Institution	City/State	Date From	Date To	Degree	Major/Minor	Semester hours	Student ID

Previous Teaching/Work Experience:

(Include Student Teaching)
(List jobs beginning with the most recent)

Employer Name	City/State	Position	Date From	Date To

Reason for Leaving:


Reason for Leaving:


Reason for Leaving:


Reason for Leaving:

*The applicant affirms that any graduate hours listed, as well as any references to prior teaching experience, represent the total accumulated prior to date of application, and as such, contribute to initial salary schedule placement. Any additional graduate hours or teaching experience information not so listed at the time of application will not be used for salary purposes, present or future.

Additional Skills:

(Job training, apprenticeships, hobbies, workshops, organizational affiliations
that relate to the area of work for which you are applying)

Characters: 500

Comments:

Characters: 500

References:

Name	City/State	Phone:
		()
		()
		()

Are you a United States citizen?YesNo

Position Preferences: Full TimePart Time

PLEASE NOTE: Board of Education policy requires that persons recommended for
positions with the Springfield Public Schools undergo a State of Illinois Criminal History
Background Investigation BEFORE approving their hire.

Have you ever been convicted of a felony?YesNo
If yes, please explain briefly.

Have you ever been convicted of a sex offense?YesNo

Have you ever been an employee of the Springfield Public School District 186?YesNo
If yes, when? What Position(s)?

Per the Illinois School Code, Section 22-6.5, it is a Class A misdemeanor punishable by
penalty of law, to provide false information or leave material omissions on the application.

The Springfield Public School System is a Equal Opportunity/Affirmative Action Employer.

It is a Class A Misdemeanor for an applicant for a school district position to
willfully make false statements on this application for employment or knowingly omit
or fail to include employment history required to be furnished on the application which is
material to the qualifications for employment.

Human Resources

Application for New Employees

Education: High School(s) and College(s) Attended & Training*:

Previous Teaching/Work Experience:

Additional Skills:

Comments:

References: