Downey Adult School

Application for Teaching Position

Personal

Last Name	First Name	Middle

Street Address	City	State & ZipCode

Telephone # Home	Telephone # Work

Please list the name and telephone number of a friend or relative with whom we could leave a message
Name	Relationship	Phone

Have you ever been convicted of a, including a conviction based on a plea of no contest, of any felony or misdemeanor in California or any other state or place?
Yes No	If yes, please explain

Credentials

Preferred Subject Area:

Other Specialties or Talents

Availability:
Days?	Afternoon?	Evenings?

Type of valid California Credentials(s) you now hold:
Type	Expiration Date

Have you applied for a California credential? Yes No
When?	Type?

Your Name as it appears on your credential

Have you passed the CBEST exam? Yes No Date

Education

School	Name and Location	Dates Attended	Degree, Diploma or Units
Colleges / Universities
Trade School
High School

Teacher Experience (List most recent first)

School Name	Telephone

Address	Dates Employed

Name of Supervisor

Course(s) Taught

School Name	Telephone

Address	Dates Employed

Name of Supervisor

Course(s) Taught

School Name	Telephone

Address	Dates Employed

Name of Supervisor

Course(s) Taught

Other Experience (Especially in those fields you wish to teach)

Firm or Employer	Telephone

Address	Dates Employed

Name of Supervisor

State Job Title and Describe Your Work

Firm or Employer	Telephone

Address	Dates Employed

Name of Supervisor

State Job Title and Describe Your Work

References (Please list persons who have supervised your work)

Name	Position	Address	Telephone

I herby certify that all statements made hereon are true and correct to the best of my knowledge and authorize investigation of all statements herein recorded. i relase from all liability persons and organizations reporting information required by the application.

The Downey Unified School District adheres to a policy of nondiscrimination regarding race, color, ancestry, religious creed, national origin, sex, physical handicap, medical condition, or age and complies with the requirements of Title IX in its employment practices and educational programs

This application will become void two years after date received. Please feel free to re-apply, if you are still interested in employement in the Downey Adult School.