2022-2023 PASCS Employment Application Question Title * 1. POSTION(S) DESIRED? Question Title * 2. FIRST AND LAST NAME? Question Title * 3. PROFESSIONAL PERSONNEL ID? Question Title * 4. PRESENT ADDRESS? Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 5. PERMANENT ADDRESS? Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 6. LIST, IN ORDER OF PREFERENCE, THE GRADES, SUBJECTS AND / OR POSITIONS FOR WHICH YOU ARE APPLYING TEACHER ADMINISTRATION SPECIAL EDUCATION INSTRUCTIONAL AIDE MAINTENANCE CROSSING GUARD Question Title * 7. CERTIFICATION (LIST ALL AREAS IN WHICH YOU HOLD VALID PENNSYLVANIA AND/OR OUT - OF- STATE TEACHING CERTIFICATES, NOTE: APPLICANTS HOLDING A CERTIFICATE FROM ANOTHER STATE MUST OBTAIN A PENNSYLVANIA CERTIFICATE IN ORDER TO TEACH IN PENNSYLVANIA PUBLIC SCHOOL AREAS OF CERTIFICATION ISSUING STATE DATE ISSUED Question Title * 8. HAVE YOU ACQUIRED TENURE IN PENNSYLVANIA? Yes No Question Title * 9. IF YES, IN WHAT DISTRICT? Question Title * 10. DATE AVAILABLE FOR EMPLOYMENT Date / Time Date Question Title * 11. IF YOU ARE NOT EMPLOYED FULL TIME, ARE YOU INTERESTED IN BEING PLACED ON OUR SUBSTITUTE LIST? Yes No Question Title * 12. LONG - TERM SUBSTITUTE? YES NO Question Title * 13. SHORT - TERM SUBSTITUTE? YES NO Question Title * 14. EDUCATIONAL BACKGROUND? HIGH SCHOOL DIPLOMAS GRADE POINT AVERAGE (GPA) COLLEGE / UNIVERSITY MAJOR / MINOR DEGREE / CREDITS EARNED GRADE POINT AVERAGE (GPA) Question Title * 15. EXPERIENCE (PRESENT OR MOST RECENT FIRST)? DATE FROM START TO END NAME OF EMPLOYER AND ADDRESS PHONE NUMBER YOUR JOB TITLE WORK PERFORMED REASON FOR LEAVING NAME AND TITLE OF SUPERVISOR FINAL YEARLY SALARY DATE FROM START TO END NAME OF EMPLOYMENT AND ADDRESS PHONE NUMBER YOUR JOB TITLE WORK PERFORMED REASON FOR LEAVING NAME AND TITLE OF SUPERVISOR FINAL YEARLY SALARY DATE FROM START TO END NAME OF EMPLOYER AND ADDRESS PHONE NUMBER YOUR JOB TITLE WORK PERFORMED REASON FOR LEAVING NAME AND TITLE OF SUPERVISOR FINAL YEARLY SALARY PLEASE LIST ACTIVITIES THAT YIOU ARE QUALIFIED TO SUPERVISE OR COACH Question Title * 16. IF YOU HAVE BEEN PREVIOUSLY EMPLOYED IN A TEACHING POSITION, PLEASE COMPLETE THE FOLLOWING? GRADE OR SUBJECT TAUGHT NAME AND ADDRESS OF SCHOOL COLLEGE SUPERVISOR COOPERATING TEACHING Question Title * 17. REFERENCES?References should include superintendents, principals, or professors who have first - hand knowledge of your professional competence and your personal qualifications. NAME POSITION ADDRESS PHONE NUMBER NAME POSITION ADDRESS PHONE NUMBER NAME POSTION ADDRESS PHONE NUMBER OTHER QUALIFICATIONSSUMMARIZE SPECIAL JOB - RELATED SKILLS AND QUALIFICATIONS ACQUIRED FROM EMPLOYMENT OR OTHER EXPERIENCES (INCLUDING U.S. MILITARY SERVICE) AND / OR STATE ANY ADDITIONAL INFORMATION YOU FEEL MY BE HELPFUL IN CONSIDERING YOUR APPLICATION, I.E. HONORS AWARDS ACTIVITIES, TECHNOLOGY SKILLS OR PROFESSIONAL DEVELOPMENT ACTIVITIES? Question Title * 18. SIGNATURE NAME NAME Done