Employment Application

Please complete the following employment application. If any of the questions are not applicable to the position you are applying for, please enter N\A.

In addition to this application, resumes should be sent to resume@lutzprep.org.

All information provided by the applicant on this form is subject to verification and review by Hillsborough County Public Schools and Lutz Preparatory Schools, Inc. Official transcripts of all college course work reflecting degree attained and major will requested prior to a confirmed offer of employment.

This application and your resume will be kept on file for a period of twelve months from the date it is received.

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* 1. Contact Information:

First Name:

Last Name:

Middle Name:

Social Security Number:

Date of Birth

Street Address:

City:

State:

Zip:

Phone Number:

Email Address:

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* 2. Please indicate the position(s) you are applying for:

Administration

Teacher

Substitute Teacher

Paraprofessional

Guidance Counselor

ESE Specialist

Office\Staff

Cafeteria

After Care Staff

Custodial

Other (please specify)

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* 3. If applying for a teaching position, please list grade level preference (multiple choices can be selected), otherwise select N/A:

N/A

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* 4. Professional Educator's Certificate:
Enter N/A if not applicable:

Lawson Number (Only for previous Hillsborough County Employees)

I hold a valid Florida teaching certificate, DOE #:

Temporary, regular, or other (please specify):

Date range valid for:

Coverages and endorsements listed on certificate:

I do not hold a Florida certificate but I am certified to teach in another state and I am eligible to apply for a Florida certificate. (List status of eligibility).

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* 5. Do you have ESOL on your certificate?

Yes

No
IMPORTANT NOTE: If you answer NO to this questions you may be required to sign an Agreement to Earn ESOL. Upon employment ALL Category I teachers will be required to complete either 3 semester hours or 60 in-service points within one year of employment as a Language Arts instructor. The teacher will be required to complete 3 semester hours or 60 in-service points each subsequent year until a total of 15 semester hours or 300 in-service points have been earned. Based on the Florida Administrative Code 6A-1.0503.

If a teacher starts in Category I and transfers to another position that has Category II – IV requirements, the teacher must complete the Category I requirements.

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* 6. Do you have the gifted Endorsement? (If you are applying for middle school Science or Math, you may be required to sign an agreement to earn your gifted endorsement).

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* 7. Do you have the Reading Endorsement on your Certificate? (Multiple positions require a reading endorsement added to your certificate including ELA, ESE, etc.)

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* 8. Professional Educator's Certificate\License:

	N/A	Yes	No
Has action ever been taken AGAINST your teaching certificate by the Florida Education Practices Commission?	Has action ever been taken AGAINST your teaching certificate by the Florida Education Practices Commission? N/A	Has action ever been taken AGAINST your teaching certificate by the Florida Education Practices Commission? Yes	Has action ever been taken AGAINST your teaching certificate by the Florida Education Practices Commission? No
Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles License, ever refused to grant you teaching certification or professional licensure?	Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles License, ever refused to grant you teaching certification or professional licensure? N/A	Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles License, ever refused to grant you teaching certification or professional licensure? Yes	Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles License, ever refused to grant you teaching certification or professional licensure? No
Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles Licensure, taken any disciplinary action against you or sanctioned your professional license and /or teaching certificate?	Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles Licensure, taken any disciplinary action against you or sanctioned your professional license and /or teaching certificate? N/A	Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles Licensure, taken any disciplinary action against you or sanctioned your professional license and /or teaching certificate? Yes	Has ANY state department or any state or government licensing agency, except the Department of Motor Vehicles Licensure, taken any disciplinary action against you or sanctioned your professional license and /or teaching certificate? No
Are you presently or have you ever been under investigation by the Florida Education Practices Commission or any other State Department of Education or Licensure Board?	Are you presently or have you ever been under investigation by the Florida Education Practices Commission or any other State Department of Education or Licensure Board? N/A	Are you presently or have you ever been under investigation by the Florida Education Practices Commission or any other State Department of Education or Licensure Board? Yes	Are you presently or have you ever been under investigation by the Florida Education Practices Commission or any other State Department of Education or Licensure Board? No
Have you ever resigned employment in lieu of disciplinary action or termination?	Have you ever resigned employment in lieu of disciplinary action or termination? N/A	Have you ever resigned employment in lieu of disciplinary action or termination? Yes	Have you ever resigned employment in lieu of disciplinary action or termination? No
Have you ever been terminated by a school district or had your contract non-renewed?	Have you ever been terminated by a school district or had your contract non-renewed? N/A	Have you ever been terminated by a school district or had your contract non-renewed? Yes	Have you ever been terminated by a school district or had your contract non-renewed? No

If you answered YES to any of the above questions, please explain the circumstances below:(enter N/A if not applicable):

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* 9. High School Educational Background:

N/A:

Name of high school attended:

Address

Year graduated:

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* 10. College or University Educational Background:

N/A:

College\University attended:

Address:

Year graduated:

Major\Degree

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* 11. Additional College or University Educational Background (if applicable):

N/A:

College\University attended:

Address:

Year graduated:

Major\Degree

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* 12. Other Educational Background (if applicable):

N/A:

Other:

Address:

Year completed:

Course of study:

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* 13. Employer #1 (please list the most recent experience first):

N\A

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

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* 14. Employer #2:

N\A

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

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* 15. Employer #3:

N\A

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

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* 16. Employer #4:

N\A

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

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* 17. As of today, what is the total years you have taught as a certified teacher (Please do not include Substitute teaching or Interning in your answer)

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* 18. Professional Reference #1:

Reference name:

Title\Position:

School or business:

Phone number:

Email Address (It is important that you include an email address for this person):

Time known:

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* 19. Professional Reference #2:

Reference name:

Title\Position:

School or business:

Phone number:

Email Address (It is important that you include an email address for this person):

Time known:

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* 20. Reference #3:

Reference name:

Title\Position:

School or business:

Phone number:

Email Address (It is important that you include an email address for this person):

Time known:

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* 21. Personal & Background Information:

	Yes	No
Are you at least 18 years of age?	Are you at least 18 years of age? Yes	Are you at least 18 years of age? No
Will you now or in the future require sponsorship for employment visa status	Will you now or in the future require sponsorship for employment visa status Yes	Will you now or in the future require sponsorship for employment visa status No
Are you legally authorized to work in the United States?	Are you legally authorized to work in the United States? Yes	Are you legally authorized to work in the United States? No
Have you been employed at Lutz Preparatory before?	Have you been employed at Lutz Preparatory before? Yes	Have you been employed at Lutz Preparatory before? No
Are you related to anyone currently employed at Lutz Preparatory Schools, Inc.?	Are you related to anyone currently employed at Lutz Preparatory Schools, Inc.? Yes	Are you related to anyone currently employed at Lutz Preparatory Schools, Inc.? No

If yes, please list employee and your relationship.

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* 22. List date you would be available to begin work at Lutz Preparatory.

PLEASE NOTE: The application of any person with a criminal history requires review and approval to determine eligibility for employment. If you have such a criminal history, your application will be held i a pending file until the review process is complete.

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* 23. CRIMINAL RECORD INFORMATION - ALL APPLICANTS PLEASE READ VERY CAREFULLY.

ATTENTION:

Under provisions in Florida Statutes 943.0585 and 943.059, the entire arrest record is revealed to school districts by the Florida Department of Law Enforcement and the FBI when fingerprints are supplied, including "sealed records" and "expunged records." Therefore, you are required to reveal such information on this application.

NOTICE TO APPLICANTS:
You must provide all information requested, regardless of whether your criminal record has been sealed in any part. Florida law allows the School Board access to sealed and/or all other criminal records. Information disclosed pursuant to this section will be evaluated on an individualized basis, taking into account the nature of the offense and underlying conduct, the relevance of the offense to the employment position(s) for which you are applying, the proximity in time of the occurrence of the offense in relation to this application, and other relevant factors. However, your failure to disclose any requested information will, in the absence of extraordinary, mitigating circumstances, result in the rejection of your application or, if the non-disclosure is discovered after your hire, the termination of your employment.

PLEASE NOTE: The application of any person with a criminal history requires review and approval to determine eligibility for employment. If you have such a criminal history, your application will be held in a pending file until the review process is complete.

	Yes	No
Have you ever been arrested or charged for a criminal offense other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)	Have you ever been arrested or charged for a criminal offense other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) Yes	Have you ever been arrested or charged for a criminal offense other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) No
Is there any criminal charge now pending against you other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)	Is there any criminal charge now pending against you other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) Yes	Is there any criminal charge now pending against you other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) No
Are you currently on probation or currently under any imposed requirements for charges other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)	Are you currently on probation or currently under any imposed requirements for charges other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) Yes	Are you currently on probation or currently under any imposed requirements for charges other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) No

If you answered YES to any of the above questions, please email additional information about your charges to: Administration@lutzprep.org for consideration.

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* 24. Supplemental Information: Please provide any additional information which may support your application: i.e., Team Teaching, Awards, Endorsements, Curriculum Writing, etc. If you have already listed these on your resume you do not need to list them again.

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* 25. Authorization for Release of Information:

I certify that the answers given by me to the foregoing questions and statements are true and correct without any falsifications,omissions, or misleading statements of any kind whatsoever. I agree that Hillsborough County Public Schools and Lutz Preparatory Schools, Inc. shall not be held liable in any respect if I am not employed or if my employment is terminated because of false or misleading statements or answers or omission made by me in this application.

In addition, I understand that a condition of the application and/or employment process may require a drug test. Before you report to the school/site as an employee, you must be fingerprinted through the Professional Standards Department Fingerprinting Office of the Hillsborough County School District. The fingerprinting process includes a criminal background check.

Applicant's signature:

I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information.

Today's date:

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* 1. Contact Information:

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* 2. Please indicate the position(s) you are applying for:

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* 3. If applying for a teaching position, please list grade level preference (multiple choices can be selected), otherwise select N/A:

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* 4. Professional Educator's Certificate:Enter N/A if not applicable:

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* 5. Do you have ESOL on your certificate?

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* 6. Do you have the gifted Endorsement? (If you are applying for middle school Science or Math, you may be required to sign an agreement to earn your gifted endorsement).

Question Title

* 7. Do you have the Reading Endorsement on your Certificate? (Multiple positions require a reading endorsement added to your certificate including ELA, ESE, etc.)

Question Title

* 8. Professional Educator's Certificate\License:

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* 9. High School Educational Background:

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* 10. College or University Educational Background:

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* 11. Additional College or University Educational Background (if applicable):

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* 12. Other Educational Background (if applicable):

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* 13. Employer #1 (please list the most recent experience first):

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* 14. Employer #2:

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* 15. Employer #3:

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* 16. Employer #4:

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* 17. As of today, what is the total years you have taught as a certified teacher (Please do not include Substitute teaching or Interning in your answer)

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* 18. Professional Reference #1:

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* 19. Professional Reference #2:

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* 20. Reference #3:

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* 21. Personal & Background Information:

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* 22. List date you would be available to begin work at Lutz Preparatory.

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* 24. Supplemental Information: Please provide any additional information which may support your application: i.e., Team Teaching, Awards, Endorsements, Curriculum Writing, etc. If you have already listed these on your resume you do not need to list them again.

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* 4. Professional Educator's Certificate:
Enter N/A if not applicable: