Application for Position in the Solvay School District

Position(s) desired

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Note: (*) Denotes required field
Personal Information
First Name *
Last Name *
Middle Initial
Home Address *
City * State * Zip *
Home Phone * Cell Phone:      Work Phone
Work Address
Retirement Number
Present Position Hourly/Salary $
Training
School Violence Prevention & Intervention (M/D/YYYY)    Child Abuse Identification (M/D/YYYY)  
NYS Certification (If applicable) (Please enter dates in M/D/YYYY format)
Area or Field of Certificate for grades    Date Issued Certification Code
Area or Field of Certificate for grades    Date Issued Certification Code
Area or Field of Certificate for grades    Date Issued Certification Code
Area or Field of Certificate
Out of State Certification (If applicable)
Area or Field of Certificate for grades    Date Issued State
Area or Field of Certificate for grades    Date Issued State
Educational Background
High School *
Location * Dates Attended
Type of Diploma Date Granted
  Distinctions and Honors
College/University *
Location * Dates Attended
Type of Degree Date Granted
Major * Distinctions and Honors
Second College/University
Location Dates Attended
Type of Degree Date Granted
Major Distinctions and Honors
Graduate Studies
Location Dates Attended
Type of Degree Date Granted
Major Distinctions and Honors
Other Graduate Studies
Location Dates Attended
Type of Degree Date Granted
Major Distinctions and Honors
Master's Degree     Yes       No
CAS     Yes       No
National Board Certification     Yes       No
ASHA Certification     Yes       No
PhD     Yes       No
Number of Graduate Semester Credit Hours    
Employment History
Employer Location and Ph. Number
Job Title Total Years
    Dates
Employer Location and Ph. Number
Job Title Total Years
    Dates
Employer Location and Ph. Number
Job Title Total Years
    Dates

College or University Teaching
School Location and Ph. Number
Subject Area Total Years
    Dates
School Location and Ph. Number
Subject Area Total Years
    Dates

Other Teaching (including substituting) (If applicable)
School Location and Ph. Number
Grade or Subject Total Years
    Dates
School Location and Ph. Number
Grade or Subject Total Years
    Dates

Student Teaching (If applicable)
School Location and Ph. Number
Grade or Subject Dates
School Location and Ph. Number
Grade or Subject Dates
Activities
Positions of leadership held or honors received in college, teaching, or in the community:
Experience in organizations you feel help qualify you for the position:
Recent participation in professional events:
Other Experiences with Children
Type of Experience City and State Kind of Work Dates Length of Service
Non - Teaching Work Experience
Name of Firm or Employer City and State Kind of Work Dates Length of Service
Military Service
In United States Armed Forces     Yes       No If yes, complete below
Length of Service      Branch      Date of Discharge
Professional References (* two required)
Name Official Position Institution Present Address Telephone
Please explain how you perceive your long-term purposes and contributions to the education of children. (If applicable)
Attach your resume:
Attach your cover letter:
Copy of certification:

*** NOTE - Please DO NOT type messages in this area. This area is for upload of documents ONLY. Typing messages here will result in a failed submission! You MUST use the "Browse" button to upload your document. ***
*** Note: Uploaded files must be in Microsoft Word or PDF format and must be smaller than 2.5 MB ***

Have you been fingerprinted?     Yes       No
Have you submitted your fingerprints to New York State Ed. Dept.?     Yes       No
Have you ever been convicted of a felony?     Yes       No
Have you ever submitted an application to the Solvay School District?     Yes       No
If so, for what position?     Position:      Date:
Have you ever been employed by the Solvay School District?     Yes       No
If yes, date and position.     
How did you learn about this opening?     
Once submitted, you will not be able to view or edit your application. Please review carefully before submitting.
Applicant’s Certification, Release, and Consent

I certify that the information contained in this application and any accompanying resume or other document is true and complete, and is not misleading, to my knowledge and belief. I understand and acknowledge that any falsification, omission, or misleading statement may cause rejection of this application, may result in my termination from employment, or have similar adverse consequences.

I hereby authorize the Solvay Union Free School District, at the time of my application for employment or at any time thereafter, to investigate my education and employment history, to perform a background check, and to access my record in the New York State Education Department TEACH Online Services System. And, I further authorize any school, college, former employer, former supervisor, reference, or any other source (whether specified in my application materials or not) so long as the information given is relevant to the duties for which I have applied, to give information to the Solvay Union Free School District relating to my education or employment history. This release is specifically intended to be sufficient under the Family Education and Privacy Rights Act (FERPA) for any school to release its records pertaining to me, which were made during my periods of attendance. I agree not to assert any claims or causes of action of any kind against the Solvay Union Free School District or any agent or employee thereof, or against any other former school, employer, criminal justice agency, or individual or its/his/her agents or employees, for any disclosures made as part of an investigation. I hereby release and forever discharge such persons or entities from any liability whatsoever for defamation, libel, slander, or invasion of privacy, as well as from any claims or causes of action of any kind, arising out of their conduct in or cooperation with such investigation.

In the event that an offer of employment is made by the Solvay Union Free School District’s superintendent, I will consent to being fingerprinted for the purposes of a background check by state and federal criminal justice agencies before my appointment is confirmed by the board of education.

The Solvay Union Free School District does not discriminate on the basis of gender in admission to or employment in its educational programs or activities. Inquiries regarding our non-discrimination policies may be made to the Title IX Coordinator John Dippold, Jr., 600 Gertrude Ave., Solvay, NY 13209-1532.


DISTRICT INFO


QUICKLINKS


SCHOOLS


Solvay Union Free School District
Lawrence Wright, Superintendent
PO Box 980
299 Bury Drive
Syracuse, New York 13209
Phone: (315) 468-1111


www.solvayschools.org

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