Please Fill Out The Beauregard Parish Head Start Professional Application Below
PROFESSIONAL APPLICATION
BEAUREGARD PARISH SCHOOL BOARD, 202 West Third Street / PO DRAWER 938 DeRidder, LA 70634 (337) 463-5551
THE BEAUREGARD PARISH SCHOOL BOARD IS AN EQUAL OPPORTUNITY EMPLOYER. WE ARE DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, CREED, COLOR, AGE, SEX, RELIGION, NATIONAL ORIGIN OR PHYSICAL DEFECTS.
NOTICE TO ALL APPLICANTS: YOUR APPLICATION WILL BE KEPT ON ACTIVE FILE FOR ONE (1) YEAR FROM THE DATE RECEIVED.
Reaquired field: DATE OF APPLICATION:
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PERSONAL DATA
Reaquired field: SOCIAL SECURITY NUMBER:
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Reaquired field: LAST NAME:
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Reaquired field: FIRST
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MIDDLE
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MAIDEN NAME
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Reaquired field: DATE OF BIRTH:
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Reaquired field: PRESENT MAILING ADDRESS:
Address
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City
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State / Province / Region
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POSITION DESIRED:
Reaquired field: POSITION
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Reaquired field: DATE AVAILABLE TO START:
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YEARS OF TEACHING EXPERIENCE
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EDUCATIONAL INFORMATION: Undergraduate Degree
Reaquired field: Name of College/University
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Reaquired field: Location of College/University
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Reaquired field: Years Attended
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Reaquired field: Year Graduated
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Reaquired field: Major and Minor
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EDUCATIONAL INFORMATION: Master's Degree
Name of College/University
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Location of College/University
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Years Attended
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Year Graduated
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Degree Obtained
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EDUCATIONAL INFORMATION: Education Specialist OR Plus 30 Graduate Hours
Name of College/University
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Location of College/University
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Years Attended
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Year Graduated
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Degree Obtained
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CERTIFICATION:
IF YOU HAVE A LOUISIANA CERTIFICATE, PROVIDE YOUR CERTIFICATE NUMBER:
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DATE CERTIFICATE WAS ISSUED:
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DATE CERTIFICATE WAS RENEWED:
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LIST ANY SPECIALTY AREAS
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IF YES, WHICH STATE?
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DATE THE CERTIFICATE WAS ISSUED:
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DATE THE CERTIFICATE WAS RENEWED:
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CERTIFIED TEACHING AREAS
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STUDENT TEACHING EXPERIENCE (SUBJECT AND/OR GRADE)
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NAME OF SUPERVISOR OF STUDENT TEACHING
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ADDRESS OF SUPERVISOR OF STUDENT TEACHING
Address
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City
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State / Province / Region
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FORMER EMPLOYERS: List below your last four employers, starting with most recent one first. Give complete addresses.
1. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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STARTING DATE:
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ENDING DATE:
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NUMBER OF YEARS EMPLOYED
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2. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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STARTING DATE:
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ENDING DATE:
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NUMBER OF YEARS EMPLOYED
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3. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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STARTING DATE:
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ENDING DATE:
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NUMBER OF YEARS EMPLOYED
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4. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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STARTING DATE:
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ENDING DATE:
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NUMBER OF YEARS EMPLOYED
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REFERENCES: List below the names of three persons (not related to you) whom you have known at least one year, or can attest to your educational experience and background.
1. NAME OF REFERENCE:
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ADDRESS OF REFERENCE:
Address
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City
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State / Province / Region
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2. NAME OF REFERENCE:
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ADDRESS OF REFERENCE:
Address
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City
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State / Province / Region
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3. NAME OF REFERENCE:
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ADDRESS OF REFERENCE:
Address
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City
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State / Province / Region
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IF YES, GIVE OFFENSE, DATE, AND OUTCOME BELOW:
BY SIGNING BELOW, I GIVE MY PERMISSION FOR THE BEAUREGARD PARISH SCHOOL BOARD TO REQUEST EVALUATION RESULTS OF ALL PREVIOUS EMPLOYMENT PERFORMANCE.
Reaquired field: SIGNATURE OF APPLICANT
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TODAY'S DATE
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BY SIGNING BELOW, I UNDERSTAND THAT IF EMPLOYED: ANY MISREPRESENTATION OR OMISSION OF FACTS REQUESTED IN THIS APPLICATION MAY BE CAUSE FOR DISMISSAL.
Reaquired field: SIGNATURE OF APPLICANT
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TODAY'S DATE
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