Administrative Service Center
460 W Street, P.O. Box 729
Bedford, IN 47421
Telephone (812) 279-3521

Action By Employing Officials  
Initial and Date After Reviewing
_____________________________     _____________
This Section for Official Use Only
_____________________________ _____________
_____________________________     _____________
Interviewed: ___________________   By: __________________________________________________
Transcript: Sent For ____________ Received _________ Credentials: Sent For ___________ Received _________
Notification Promised By ______________________________ Letter _________________ Phone ___________
Educational Employment
Please fill out blanks with complete, detailed information.
You are encouraged to attach a vita sheet.
Date of Application: 7/18/2019
  First Middle Maiden Last  
Present Address:
Present Telephone Number:
Permanent Address :
Permanent Telephone Number:
Email Address:

Note: Before Employment, A Personal Interview is Necessary
Have you previously applied for a position in this school system? Yes No    Date
Please list the types of positions you desire, in order of preference:
(1) (2) (3)

List Major Teaching Area(s)
List Minor Teaching Area(s)
Sports which you are qualified to coach:
Sports which you have a desire to coach:
Other activities which you can sponsor/supervise:
License Information
Type of License
(Elem., Sec., etc)
Or Professional
Date of
Subject Area
Mentorship Required: Yes No
Education and Professional Training
Type of School Name & Location of Schools Courses Majored In Degree or Diploma
High School Diploma Yes No
College List Degree
Sem. Hrs.
College List Degree
Sem. Hrs.
Graduate School List Degree
Sem. Hrs.
Scholastic Standing in High School    In College

Work Experience Other Than Teaching In Last Five Years
Name And Location Of Company
(Begin with most recent)
Kind Of Business From
ex) 01/2001
Reasons For Leaving
Teaching Experience
Name And Address Of School
(Begin with most recent experience. List student teaching if less than five years of teaching experience.)
Grades/Subjects From
ex) 01/2001
Reasons For Leaving
Coaching And Other Extra Curricular Experience
Name And Location Of School
(Begin with most recent experience.)
Activity From
Reasons For Leaving
Give references including Supervising Teachers, Principals, and Superintendents under which you have taught or student taught.
  Name Address Phone Official Position
Name under which transcripts and employment records may be indentified if different from your present name:
College Placement File Number; if known No. College:
  No. College:
Important Salary Information
The basis upon which salary would be computed    
  Number of years of military service   Check All Degrees Received:
  Number of years teaching   BS
  Number of years Administration   BA
        Ed. Spec.
        Ed. D.
  Semester hours above masters' degree   Ph. D.

Who referred you to this school district?
Date available to begin employment:

Applicants shall name all persons currently on the rolls of the corporation who are related to the applicant by blood or by marriage, provided that no applicant shall be required to name a relative more distant than a first cousin.
In a short statement below, tell us why you have applied for a position in the North Lawrence Community Schools

I hereby certify that to the best of my knowledge the foregoing statements are true and complete. I further understand that this application will become a part of my permanent personnel file should I become employed by the North Lawrence Community Schools. I also signify by submitting this application electronically that permission is given for this prospective employer to receive and view any copies of my school or college record, or any references that I or the school system may select without my inspection of the information.
Note: This application will be kept active for two (2) years unless employed during that time.

If you are hired for a position with North Lawrence Community Schools, administrative personnel must process a criminal history check. The applicant will be required to cover the cost for the criminal history check. If you are hired for a position with North Lawrence Community Schools, administrative personnel must process a criminal history check/child abuse registry check. You will receive an invitation by email from the personnel department to process this information through Safe hiring solutions and payment will need to be made by credit/debit card.

An authorization form must be completed before the Criminal History check is done.

The North Lawrence Community School Corporation does not discriminate against any individual because of race, sex, color, religion, creed, age, national origin, or physical handicap in the operation of its educational programs or activities.