WahlukeSchoolDistrict73.doc

Wahluke School District #73 411 East Saddle Mountain Drive P.O. Box 907 Mattawa, WA 99349 (509) 932-4565 (509) 932-4571 fax Certificated Personnel Application for Employment Do you wish to apply for: ( Regular Employment ( Substitute Employment ____________________________________________ ________________________________ Name: Last, First, Middle Social Security Number ____________________________________________ ________________________________ Address Phone Number ____________________________________________ ________________________________ City, State, Zip Code Alternate Phone Number ____________________________________________ ________________________________ Alternate Address City, State, Zip Code Placement Preference: Please indicate desired position(s) in order of preference. ___________________________ __________________________ _________________________ First Choice Second Choice Third Choice Certification: Do you hold a Washington State Teaching Certificate ? { } yes { } no If no: _______________________ Application date _______________________________________________ ____________________________ Type of Certificate: (teaching, counseling, principal) Certificate Number Level of Certificate: { } Standard { } Continuing { } Initial { } Residency { } Professional ___________________________ __________________________ ____________________________ Teaching Endorsement (s) Please Indicate Primary or Secondary Teaching or other work experience in the field of education Name of School or Employer Dates Position/Grade/Subject Supervisor Phone # What student activities are you prepared and willing to direct or coach? _____________________________________________________________________________________ Are you bilingual and/or biliterate? ( ( Yes ( ( No What langu