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| 1. |
List all teaching endorsements by name as listed on your license.
Short Essay (Answer limited to 600 characters, including spaces)
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| 2. |
Do you hold a current Virginia teaching/administrator certification for the position for which you are applying? If so, please list license number and expiration date.
Short Essay (Answer limited to 600 characters, including spaces)
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| 3. |
Do you hold a valid teaching certificate in a state other than Virginia? If so, where? Please list the exact title, license number, and expiration date.
Short Essay (Answer limited to 600 characters, including spaces)
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| 4. |
If you do not hold a current teaching/administrator license, when will you be eligible for a license?
Brief Response (Answer limited to 200 characters, including spaces)
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| 5. |
Do you have a family member who serves as the Division Superintendent or as a School Board member: If yes, please identify by name.
Yes/No
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| 6. |
Do you have a family member (defined as father, mother, brother, sister, spouse, son, daughter, father-in-law, mother-in-law, son-in-law, daughter-in-law, sister-in-law or brother-in-law) who is employed with MCPS? If yes, please identify by name and list the school or department where they work.
Yes/No
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| 7. |
Have you ever been involuntarily terminated from employment or resigned in lieu of termination? If yes, please explain stating the name of the employer, the date of termination or resignation, and the reason for the separation.
Yes/No
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| 8. |
Do you have any physical condition(s) which may limit your ability to perform the particular job for which you are applying? If yes, please indicate what accommodation is needed.
Yes/No
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| 9. |
If hired by MCPS, I understand that my contract will be withdrawn if I knowingly and willfully procure, sell, or administer anabolic steroids or cause such drugs to be procured, sold, or administered to a student, or if I fail to report the use of such drugs by a student to a school administrator as required by the Code of Virginia 54.1-3401
Yes/No
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| 10. |
Have you resided in any other state(s) besides Virginia in the past five years? If yes, please indicate the state(s), county(ies), city(ies) and/or town(s).
Yes/No
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| 11. |
I understand that by applying to MCPS I am giving my permission to solicit information from the State Child Abuse and Neglect Central Registry from each state that I have resided in during the past five years.
Yes/No
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| 12. |
For purposes of compliance with Section 40.1-11.1 of the Code of Virginia, entitled "Employment of Illegal Immigrants," are you legally eligible for employment in the United States?
Yes/No
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| 13. |
If you do not hold a current teaching/administrator license, are you eligible for a license from Virginia for the position for which you are applying?
Yes/No
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| 14. |
Have you ever been convicted of a felony?
Yes/No
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| 15. |
I hereby authorize the Office of Personnel to conduct work history, personal references, or police record inquiries and waive the right to hold liable those persons for providing any requested information. It is understood that such information is to be absolutely privileged, confidential, and used only in determining my qualifications for employment and assignment.
Yes/No
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| 16. |
Has your teaching license ever been suspended or revoked? If yes, please give details.
Multiple Choice / Single Answer
- Yes
- No
- I do not hold a teaching license
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| 17. |
Have you ever been convicted of a crime of moral turpitude (i.e. lying, cheating, or stealing) or any offense involving the sexual molestation, physical or sexual abuse or rape of a child? If yes, please include an explanation.
Multiple Choice / Single Answer
- Yes
- No
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| 18. |
Have you ever been charged and found guilty of child abuse and/or neglect? If yes, please include an explanation.
Multiple Choice / Single Answer
- Yes
- No
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| 19. |
Are any criminal charges or proceedings pending against you? If yes, please include an explanation.
Multiple Choice / Single Answer
- Yes
- No
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| 20. |
Have you ever been charged with or convicted of the possession, sale, use, and/or distribution of any illegal substance? If yes, please include an explanation.
Multiple Choice / Single Answer
- Yes
- No
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| 21. |
Are you interested in (please check all that apply):
Multiple Choice / Multiple Answers
- Part time employment
- Full time employment
- Temporary employment
- Substitute employment
- Any of the above
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| 22. |
Indicate the highest level of education completed (please check all that apply):
Multiple Choice / Multiple Answers
- High School Diploma or GED
- Associate's Degree
- Bachelor's Degree
- Master's Degree
- Ed.D or Ph.D.
- Completion of 48 Semester Hours of College
- Completion of 60 Semester Hours of College
- None of the above
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| 23. |
Please indicate the type of teaching license/certificate you possess:
Multiple Choice / Multiple Answers
- Collegiate Professional
- Division Superintendent
- Postgraduate Professional
- Provisional
- Pupil Personnel Services
- Statement of Eligibility
- Technical Professional
- None of the above
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| 24. |
Please indicate your availability to substitute:
Multiple Choice / Multiple Answers
- Any day / any time
- Monday full day
- Tuesday full day
- Wednesday full day
- Thursday full day
- Friday full day
- Monday AM
- Tuesday AM
- Wednesday AM
- Thursday AM
- Friday AM
- Monday PM
- Tuesday PM
- Wednesday PM
- Thursday PM
- Friday PM
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| 25. |
Please check each of the following substitute position(s) you are interested in:
Multiple Choice / Multiple Answers
- Teacher
- Aide - Instructional
- Aide - Special Education
- Aide - Lunch
- Aide - Clerical
- Administrative Assistant
- Nurse (must be a licensed Registered Nurse)
- Homebound Teacher (must hold a current VA teaching license)
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| 26. |
Please indicate your school preference(s):
Multiple Choice / Multiple Answers
- All Schools
- Auburn Elementary
- Belview Elementary (Christiansburg)
- Christiansburg Primary (K-2)
- Christiansburg Elementary (3-5)
- Eastern Montgomery Elementary (Shawsville)
- Falling Branch Elementary (Christiansburg)
- Gilbert Linkous Elementary (Blacksburg)
- Harding Avenue Elementary (Blacksburg)
- Kipps Elementary (Blacksburg)
- Margaret Beeks Elementary (Blacksburg)
- Price's Fork Elementary (Blacksburg)
- Auburn Middle
- Blacksburg Middle
- Christiansburg Middle
- Shawsville Middle
- Auburn High
- Blacksburg High
- Christiansburg High
- Eastern Montgomery High (Shawsville)
- Independence Secondary
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| 27. |
Please indicate your skills below. Check all skills that apply.
Multiple Choice / Multiple Answers
- Ability to assist students with safe and orderly behavior in all school environments
- Ability to be dependable and punctual
- Ability to maintain an unquestionable degree of confidentiality
- Ability to multi-task, work with interruptions, and work under pressure
- Ability to read, comprehend, and complete forms/paperwork
- Ability to understand and follow verbal/written communication
- Ability to work flexible hours as required
- Ability to work independently while consistently demonstrating a professional level of reliability
- Demonstrate mature and responsible decision making skills
- Ability to type 50 wpm with five or fewer errors
- Licensed registered nurse (RN)
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| 28. |
I agree that any willful omission or falsification of material facts in this application, which would ordinarily be used as a basis for not hiring me, will constitute sufficient reason for immediate dismissal. I understand that unless this application is completed in detail, it may not be considered.
Yes/No
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| 29. |
I hereby certify that all statements are true, complete and correct to the best of my knowledge and belief. I understand that if employed, the terms of the contract are subject to change should the information provided be inaccurate or not officially verifiable.
Yes/No
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| 30. |
Additional Information
Long Essay (Answer limited to 4000 characters, including spaces)
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