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********************************************************************************************* CPS - Application for Employment
Chesapeake
Public
Schools
Personnel Department - Post Office Box 16496 - Chesapeake, Virginia 23328-6496
APPLICATION FOR EMPLOYMENT
[online only -- not suitable for printing]
For information about the application process or to have an application mailed to you, contact Personnel at (757)547-0001.
In order to assist us in evaluating your qualifications, we have asked for specific personal information. In accordance with the Virginia Privacy Act of 1975, you are not required to furnish your social security number because it is not essential in processing your application. However, you will be required to furnish it if you become employed by the Chesapeake Public Schools.

The Chesapeake Public Schools is an equal educational opportunity school system. The School Board of the City of Chesapeake also adheres to the principles of equal opportunity in employment and, therefore, prohibits discrimination in terms and conditions of employment on the basis of race, sex, national origin, color, religion, age, or disability.

*Required Fields

I. GENERAL INFORMATION		 Social Security Number
(Use format 111-22-3333)

Name *E-Mail
*Last *First *Middle/Maiden

Present
Address
*Street *City *State *Zip *Phone
Check this box if your permanent address is the same as your present address
Permanent
Address
Street City State Zip Phone

*Date of Availability (mm/dd/yy) May we contact you at work? Yes   No
Work Telephone Number

*II. POSITIONS DESIRED: Full Time    Part Time    Both    Temporary (Extra Staff)    Substitute Work (non-teaching)

Account Clerk Groundskeeper Press Operator
Accountant Guidance Counselor School Psychologist
Administrator/Supervisor Health Advisor (Nurse) School Social Worker
Automotive Technician Hot Copy Operator Secretarial/Clerical
Bus Assistant HVAC Mechanic Security Monitor
Bus Driver In-School Suspension Coordinator Shop Supervisor
Carpenter Interpreter (for Hearing Impaired) Speech Therapist
Custodian Job Coach Systems Engineer
Data Entry Clerk Media Assistant (Clerk) Teacher
Deliveryperson Media Specialist Teacher Assistant
Electrician Occupational Therapist Technical Support Specialist
Electronic Technician Painter Vocational Counselor
Finisher Physical Therapist Other (Specify)
Food Service Worker Plumber

*III. TEACHERS: Indicate level(s) or area(s) of licensure.
Early Education (NK-4) General Mathematics Social Studies
Middle Education (4-8) General Science Sociology
(Check all areas of concentration) Geography Spanish
Language Arts German Speech Communication
Science Gifted/Talented Technology Education
Mathematics Guidance Counselor Theater Arts
Social Science Health Trade & Industrial Education
Secondary Education(8-12) History and Social Science Other (Specify)
Specialized Studies Home Ec/Fam & Cons Sci
Algebra Journalism Special Education K-12
Art Education Latin Select desired level(s) 1st, 2nd, or 3rd below:
Biology Library-Media Specialist Elementary  Middle  High
Business Education Marketing Education Emotionally Disturbed
Chemistry Mathematics Hearing Impaired
Computer Science Music Education (Choral) Learning Disabled
Driver Education Music Education (Instrumental) Mentally Retarded
Earth & Space Science Physical Education Preschool Handicapped/Early Childhood
English as a Second Language Physics Severe Disabilities
English Education Psychology Speech-Language Disorders
French Reading Specialist Visually Impaired

IV. Requesting a Substitute Teacher Position  Yes  No
Geographic preferences: Grade Level(s) Preferred:
Crestwood Area   Greenbrier Area   South Norfolk Area
Deep Creek Area   Hickory Area   Western Branch Area
Great Bridge Area   Indian River Area
Elementary  Middle  Secondary

V. Complete the following section if you have applied for one of the positions listed below. Otherwise, skip to the section labeled "VI. ALL OTHER APPLICANTS."
  • administrator/supervisor
  • guidance counselor
  • health advisor
  • media specialist
  • occupational therapist
  • physical therapist
  • school psychologist
  • school social worker
  • speech therapist
  • teacher (non-substitute)
  • vocational counselor
    •

    *PROFESSIONAL PREPARATION
    List Your highest level of education attained on the top line.
    Education
    Name of High School and College(s) Attended:    		 Dates of Attendance Degree & Date
    Conferred    		 Major/Specialty
    From
    (Mo/Yr)    		 To
    (Mo/Yr)

    Student Teaching Experiences
    School    		 Location & Address
     (Street, City, State, Zip)    		 Grade/Subject
    Taught    		 Inclusive Date
    From (Mo/Yr) To (Mo/Yr)

    Cooperating Teacher(s):
    Name  
    Address  

    Name  
    Address  
    CERTIFICATION RELATED DATA:
    A.   Certificate(s) held:   State(s):
    Expiration date(s):   Subject or grade endorsed to teach:
    National Board Certification: Yes  No          Date:
    B.   Have you taken the Praxis or National Teacher Exams? Yes  No
    If yes, scores must be sent to the Personnel Department.

    PROFESSIONAL EXPERIENCE (list most recent employment first and include military service)
    Name and Address of School System or
    other Employer    		 Date Part-time/
    Full-time    		 Grade/Subject
    Taught or Position    		 Reason for
    Leaving
    From(Mo/Yr) To(Mo/Yr)

    Explain any breaks in service.

    OTHER INFORMATION:
    If you could select two co-curricular activities to sponsor, coach or direct, what would you choose? Why? What are your qualifications in each of these areas?
    First Activity: Second Activity:


    List any special honors or achievements that you earned while in high school, college, or while employed elsewhere.


    VI. ALL OTHER APPLICANTS
    *EDUCATIONAL BACKGROUND
    List Your highest level of education attained on the top line.
    Name & Complete Address of High School, College, Trade, Vocational, Business, or Military School(s) Attended. Dates of Attendance Did you
    Graduate?    		 Area of
    Study    		 Type of Degree, License, or Certificate Earned.
    From (Mo./Yr.) To (Mo./Yr.)
    High School Equivalency Certificate (GED) or Another Equivalency Certificate (Indicate Name of Certificate and Name and Complete Address of Issuing School or Agency.) Date Certificate Awarded(mm/dd/yy)
    SPECIALTY AREAS: Do you have any training or experience in the following areas? COMPUTERS
    Yes   No    		 MANAGEMENT/SUPERVISION
    Yes   No    		 ACCOUNTING
    Yes   No
    Describe any special training or the use of machinery (office or heavy equipment) which may relate to the position(s)
    for which you are applying.

    Work term: 10 months   11 months   12 months
    Will you accept short-term assignments? Yes  No
    Will you accept long-term assignments? Yes  No
    Will you accept half-day assignments? Yes  No
    Full-Time Student
    (Undergraduate - 12 or more hours)
    (Graduate - 9 or more hours)

    Explain any "no" responses.

    WORK EXPERIENCE (list the most recent employment first and include military service)
    1.
    Name & Address of Employer    		 Date Part-time
    Full-time
    From (Mo/Yr) To (Mo/Yr)
    Position/Duties
    Reason for Leaving
    Supervisor
    Phone
    2.
    Name & Address of Employer    		 Date Part-time
    Full-time
    From (Mo/Yr) To (Mo/Yr)
    Position/Duties
    Reason for Leaving
    Supervisor
    Phone
    3.
    Name & Address of Employer    		 Date Part-time
    Full-time
    From (Mo/Yr) To (Mo/Yr)
    Position/Duties
    Reason for Leaving
    Supervisor
    Phone
    4.
    Name & Address of Employer    		 Date Part-time
    Full-time
    From (Mo/Yr) To (Mo/Yr)
    Position/Duties
    Reason for Leaving
    Supervisor
    Phone
    May we reference your current employer?     Yes  No

    Explain any breaks in service.


    VII. TO BE COMPLETED BY ALL APPLICANTS
    *REFERENCES May we reference your current employer?     Yes  No
    List below at least four references (not relatives) including administrators, principals, supervisors, and other employers who have firsthand knowledge of your abilities. (Start with most recent employer.)
    Please note: Because classroom teachers work on a ten-month basis and are not at their respective schools during the summer months, it is important that when listing teachers as references you use their home addresses and not their school addresses, as failure to do this will slow down your application process for an indefinite period of time. Thank you for your cooperation.

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:

    Name Complete Address (Street, City, State, Zip) Position
    E-Mail Telephone #: Fax #:


    *You must check either yes or no for required questions section VIII.
    VIII.  Yes No
    A. If you are not a citizen of the United States, are you eligible to work in the U.S.?
    B. Do you have a work visa? (Your visa must be presented prior to employment.)

    C. What type of visa do you have?                 

    		   
    D. What is the expiration date on your visa?   

    		   
    *E. Are you a former employee of Chesapeake Public Schools?
    If a former employee, include the name under which you were employed, title of the position, and the dates employed.

    *F. Do you have any relatives presently working for Chesapeake Public Schools?
    Relationship     Position 
    Work Location 

    *G. Are you under continuing contract?

    *H. Have you been discharged or requested to resign from a former position? (If yes, explain below.)
    *I. Have you ever been refused renewal of a teaching contract? (If yes, explain below.)
    *J. Have you ever been convicted of any offense involving the sexual molestation, physical or sexual abuse, or rape of a child? (If yes, explain below.)
    *K. Have you ever been convicted of a crime other than the above?(Omit minor traffic violations and expunged [erased] convictions. Include dates and charges in explanation below.)
    Explanation for questions H-K


    *IX. APPLICANT WRITTEN EXERCISE
    Please respond to only two of the following questions. Answer the first question and either number two or number three.

    1. Why did you elect to file an application for employment with the Chesapeake Public Schools?


    2. What are your career goals?


    3. Identify and describe a personal quality or skill which would enhance your performance in the position you seek with Chesapeake Public Schools?

    IMMIGRATION AND NATURALIZATION SERVICE DATA

    The Immigration Reform and Control Act of 1986 requires employers to verify identity and employment eligibility for new employees. We are required to verify one document from List A or one each from List B and List C.

    List A
  • United States Passport
  • Certificate of U. S. Citizenship
  • Certificate of Naturalization
  • Unexpired foreign passport with attached Employment Authorization
  • Alien Registration Card with photograph
    		•  List B
  • A State-issued driver's license, a state-issued I.D. card with a photograph, or information including name, sex, date of birth, height, weight, and color of eyes (the state of issue must be specified)
  • U.S. Military Card
  • Other (document and issuing authority must be specified)
    		•  List C
  • An original Social Security Number Card (Other than a card stating it is not valid for Employment)
  • A birth certificate issued by state, county, or municipal authority bearing a seal or other Certification
  • An unexpired Immigration and Naturalization Service Employment Authorization form (form number must be specified)
    		•

    CONDITIONS
    Interviews and/or employment may not be offered until the application process has been completed. This process requires that the following items be received:
  • A completed application form
  • Transcripts of all college work completed (may be unofficial)
  • If applicable, National Teacher Examinations (scores on core battery and one specialty area) or Praxis (and specialty area test) required; not required if you already hold a Virginia teaching certificate. (Please send copy of license.)
  • A copy of your placement file, if applicable. Have you requested that your file be forwarded to this office? Yes     No


    • A. After one year, applications are placed in the inactive files unless the applicant advises Chesapeake Public Schools of further interest and availability.

    B. All materials submitted with this application become the property of Chesapeake Public Schools.

    C. Falsification or omissions on this application and related materials may be sufficient cause for denial or termination of employment.

    I hereby grant the Chesapeake Public Schools permission to investigate my suitability for employment based on information contained herein. I authorize my present and previous employer(s) and others who have knowledge of my professional qualifications to respond to requests from Chesapeake Public Schools for confidential information.

    *By placing your initials in the block to the right you agree that this serves as your signature.

    An Equal Opportunity Employer