Pinal County Certified Teaching Application

District Directory

Apache Junction Unified www.ajusd.org Oracle Elementary www.osd2.org
Casa Grande Elementary www.cgelem.k12.az.us Picacho Elementary www.picacho.k12.az.us
Casa Grande Union High School www.cguhs.org Ray Unified www.rayusd.org
Coolidge Unified www.coolidgeschools.org Red Rock Elementary www.redrockschools.net
Eloy Elementary www.geocities.com/athens/delphi/8352 Sacaton Elementary www.sacatonchools.org
Florence Unified www.florenceusd.org Santa Cruz Valley Union High School www.svuhs.org
JO Combs Unified www.jocombs.org Stanfield Elementary www.stanfield.k12.az.us
Mammoth San Manuel Unified www.msmusd.k12.az.us Superior Unified www.superior.k12.az.us
Maricopa Unified www.musd20.org Toltec Elementary www.toltec.k12.az.us
Mary C. O'Brien Accommodation District www.pinalcountyschools.org Pinal County School Office www.pinalcso.org

Date Of Application:

Personal Data

Name:
Address:
City:
State:
Zip:
Home Phone #:
Cell Phone #:
Email Address:  

Position

Teacher Administrator Therapist

Current Certification

Type: State:
Content Area: Endorsements:
Arizona Certification: If applied for, list date of application:
List any deficiencies:
Fingerprint Card: Expiration Date:

Employment Record (May include student teaching.)

Name of School
Complete Address
Grades or Subjects Taught
# of Years
Dates: Mo/Yr Beginning
Dates: Mo/Yr Ending
Reason for Leaving

Additional Employment Information

1. Are you currently reveiving benefits from Arizona State Returement System?
2. Are you currently under contract with another district?
    If yes, where? Contractual dates?  

Criminal Activity Report

1. Have you used any other names other than the name you are using on this application?
2. Have you ever been convicted of any misdemeanor offense(s) other than traffic violation(s)?
3. Have you ever been convicted of a DUI offense?
4. Have you ever been convicted of a felony?
5.Have you ever been convicted of a sex or drug related offense?
6. Have you ever been convicted of a dangerours crime against children as defined in A.R.S. 13.601.01?
7. Have you ever been arrested for any offense which has not yet been resolved?

Educational Preparation

Degrees
Name of Institution
Location City, State
Graduation Year
Major
Minor
GPA

References (Personal, Professional)

Name
Relationship
Years Known
Official Position
Work Phone
Home Phone

Summary of Additional Information

Work experience, military experience, additional education, awards, associations, affiliations and continuation of other items.

Please check boxes below:
I certify to the best of my knowledge all answers and statements herein are true and I understand that any misstatement or omission of fact will subject me to disqualification or dismissal.
I hereby authoprize each school district to verify all information contained in this application. Pinal County Schools are Equal Opportunity Employers.
Note: Please check the district you would like to receive this application or fax, mail or e-mail application to the respective school district of your choice.