Oswego County BOCES

Employment Application for Oswego County BOCES

Oswego County BOCES
179 County Route 64
Mexico, New York 13114

Position Applying for :

Personal Information

First Name:	Last Name:	Middle:

Address:	City:	State:	Zip:

Phone Number:	Soc. Sec. No.:	Retirement No.:
	(voluntary)
Have you ever been convicted of a crime?*

If yes, explain

*(A conviction will not necessarily disqualify an applicant for employment.)
Finger printed pursuant to Part 87 of the Regulations of the Commissioner of Education ?
(Criminal/History Record Check for Prospective School Employees & Applicants for Certification)?

Dishonorable Discharge?	Exempt Volunteer Fireman?

Certification/License

New York State Teaching/Teaching Assistant/Administrative Certificate(s)
Subject Area:	Type:*	Effective Date:	Expiration Date:


*Teaching/Administrative: Provisional, Permanent, Initial, Professional, Transitional
Teaching Assistant: Temporary, Continuing, Level I, Level II, Level III, Pre-Professional
Other licenses held: type and issuing authority

NYSTCE Test Results(Teachers only)

New York State Teaching/Teaching Assistant/Administrative Certificate(s)
Test:	Taken:	Passed

Educational Preparation

Name and Location of High School		Nature of Studies		Graduate ?

Name and Location of College(Graduate)	Dates Attended	Nature of Studies	Degree	Graduate ?

Name and Location of Vocational/Technical/ Trade School	Dates Attended	Nature of Studies	Degree	Graduate ?

Teaching or Administrative Experience

Other Work Experience

Civil Service Status

Some positions in BOCES are competitive civil service positions. Appointments must be made from the appropriate eligible lists supplied by the Oswego County Department of Personnel.
Tested by the Oswego County Civil Service Department ?

If yes, indicate what test(s) and dates taken.

Tenure Status

Were you ever appointed on tenure in a public school district in New York?

If yes, complete the following.
Tenure Area	Effective Date

Were you ever dismissed from the school district conferring tenure pursuant to Education Law Section 3020a?

Name and Address of School District where tenure was granted

Professional & Scholastic Organizations, Memberships, Honors

Exclude organizations, the nature or character of which indicates the race, creed, color or national origin of its members.

Other Skills and Abilities

For example: coaching, knowledge of sign language, technology skills.

References

List three individuals having personal knowledge of your professional training, ability, experience and personal character. Include the name, address and telephone of your last supervisor who may be contacted for a personal or professional reference.
Name	Position	Address	Phone



May we refer to your present employer?
May we refer to your former employer?
Placement folder may be secured from:(Name and Address).

Applicant's Statement

Give any additional information which you think might be of value in considering you for a position.