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Certified Employment Application


You may also apply in person with the district’s Human Resources Department

Please Fill Out The Form Below

Please check position(s) for which you are applying:

Do you have the legal right to accept employment in the United States?
If No, have you applied for work authorization?


Min: 3 Max: 20
Min: 3 Max: 20
Min: 1 Max: 20

Current Address:

Min: 1 Max: 5

II. EMPLOYMENT PREFERENCE(S) Indicate below the area(s) in which you are qualified to teach:
Elementary (K-5) (check preferences) Requires Arizona elementary certification. *Requires Early Childhood certification/endorsement by 2009-2010.
Middle School (6-9) (check preferences) Requires Arizona certification and one of the following: academic major or equivalent hours (at least 24 semester hours), graduate degree, advanced certification, or the Arizona Subject Knowledge Proficiency Exam.



Type N/A if not applicable.

Arizona Certification

Fingerprint Clearance Card

Type N/A if not applicable.

Out-of-State Certification:

National Board Certification:

An out-of-state teacher who relocates to Arizona may obtain a one-year reciprocal teaching certificate if the teacher possesses a valid teaching certificate from a state with similar criminal history requirements.

Student Teaching Experience

Address of School

Min: 1 Max: 5

List all Teaching Experience (most recent first). Attach an additional page if necessary.

Employment Other Than Teaching (list most recent first; clarify gaps in employment):


Type N/A if not applicable.

VII. PROFESSIONAL SUPERVISORY REFERENCES (references MUST cover the past two years)

1. Have you ever been convicted of, admitted convicting, or are you awaiting trial for any crime (excluding only minor traffic violations not involving any allegation of drug or alcohol impairment:)?
2. Have you ever been dismissed (fired) from any job, or resigned at the request of your employer, or while charges against you or an investigation of your behavior was pending?
3. Have you ever had any license or certificate of any kind (teaching certificate or otherwise) revoked or suspended, or have you in any way been sanctioned by, or is any charge or complaint now pending against you before any licensing, certification or other regulatory agency or body, public or private?
Are you now being investigated for any alleged misconduct or other alleged grounds for discipline by any licensing, certification or other regulatory body (teacher certification or otherwise) or by your current or any previous employer?
Are you currently under contract in another district?

If available, submit copies of the following items with your application:

1. Copy of your Arizona Teaching Certificate. 2. Copy of your Education Proficiency Assessment test results 3. Copy of your Arizona fingerprint clearance card.

Applications must include:

1. A current resume. 2. Legible copies of transcripts. 3. Three letters of professional recommendation including letters from teaching supervisors. If you do not have teaching experience, letters of reference are acceptable







Please answer each question below. Attach an additional sheet if necessary

My signature below indicates that I HAVE READ, I UNDERSTAND, AND I AGREE to the following:

It is the policy of the participating districts not to discriminate on the basis of race, color, religion, gender (including sexual harassment as described in the districts’ policies concerning sexual harassment), sexual orientation, age, national origin, disability, marital status, political affiliation, or veteran status in its educational programs, activities or employment policies as required by federal law. The districts abide by federal laws regarding people with disabilities. If you have a special need, reasonable accommodations will be made in accordance with the American Disabilities Act of 1990. Inquiries regarding compliance with any of the above may be directed to the individual districts’ Human Resources Department; or to the Director of the Office For Civil Rights, U.S. Department of Education, Federal Office Building, 1244 Speer Blvd., Suite 310, Denver, CO 80204-3582. Every answer I have provided on this application is both complete and truthful. I understand and agree that: (1) if any information is omitted from, or not filled in on this application, or if any false information is furnished, the districts will reject my application; (2) if any false information is furnished, I will be ineligible for any consideration for employment and may be subject to criminal prosecution; and (3) if I am employed by a district, I may be dismissed from employment, criminally prosecuted, and if certified, my certificate may be revoked, if it is later determined that I have furnished false information on this application. I understand that in order for any of these districts to determine my eligibility, qualifications and suitability for employment, the school district will conduct a background investigation if I am considered for an offer of employment. This investigation may include asking my current and any former employer and educational institution I have attended about my education training, experience, qualifications, job performance, professional conduct, and evaluations; as well as confirming my dates of employment or enrollment, position(s) held, reason(s) for leaving employment, whether I could be rehired, reason for not rehiring (if applicable), and similar information. In addition, I understand that the District will confirm my fingerprint clearance is still valid. I hereby certify that I am not awaiting trial on and have never been convicted of or admitted in open court or pursuant to a plea agreement committing any of the following criminal offenses in this state or similar offenses in another jurisdiction: Sexual abuse of a minor; incest; first or second degree murder; kidnapping; arson; sexual assault; sexual exploitation of a minor; felony offenses involving contributing to the delinquency of a minor; commercial sexual exploitation of a minor; felony offenses involving sale, distribution or transportation of, offer to sell, transport or distribute or conspiracy to sell, transport or distribute marijuana, dangerous drugs or narcotic drugs; felony offenses involving the possession or use of marijuana, dangerous drugs or narcotic drugs; burglary; aggravated or armed robbery; robbery; a dangerous crime against children as defined in section 13-604.01; child abuse; sexual conduct with a minor; molestation of a child; manslaughter; assault or aggravated assault; exploitation of minors involving drug offenses; driving under the influence of intoxicating liquor or drugs, or aggravated driving under the influence of intoxicating liquor or drugs; offenses involving domestic violence. If employed by any of these school districts, employment is conditional and rests upon (a) satisfactory pre-employment reference checks, (b) results of fingerprint check, and is subject to (c) the policies and regulations of the district, (d) submitting documentary proof of authorization to work in the United States, (e) and, if required, appropriate state certification/licensing. Employment will not be finalized until the background investigation has been completed. Misrepresentation or omission of pertinent facts may be cause for termination. Parties providing this information will be released from any liability in connection with reference and fingerprint checks made by the district. Under penalty of prosecution and termination, I hereby certify that the information presented on this application is true, accurate and complete. I authorize the investigation of all statements contained herein and understand that any document relevant to this information may be reviewed by agents of the school district. (Before signing, make copies of the application for each district to which you will apply. Affix your original signature to each copy.)

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this form electronically. You agree your typed name above is the legal equivalent of your manual signature

Required Fields