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SCHOOL DISTRICT OF PHILADELPHIA

OFFICE OF HUMAN RESOURCES
440 NORTH BROAD STREET
PHILADELPHIA, PENNSYLVANIA 19130
(215) 400-4610

TO PR OSPECTIVE TEA
PROSPECTIVE CHER:
TEACHER:

WE ARE PLEASED THAT YOU ARE INTERESTED IN EMPLOYMENT WITH THE SCHOOL DISTRICT OF PHILADELPHIA. WE HOPE
THAT YOU ARE SUCCESSFUL IN OUR SELECTION PROCESS AND WILL BECOME PART OF THE TEAM HELPING OUR STUDENTS
ACHIEVE THEIR FULLEST POTENTIAL.

WE ARE IN THE PROCESS OF GATHERING STATISTICAL DATA REGARDING OUR RECRUITMENT EFFORTS. THEREFORE, WE ARE
REQUESTING THAT YOU COMPLETE THE SURVEY BELOW. AFTER YOU HAVE FINISHED THE SURVEY, PLEASE COMPLETE THE
APPROPRIATE INFORMATION IN SECTIONS 1, 2, 3, 4 AND 5, AND THEN PROCEED TO THE FOLLOWING PAGES.

DATE OF SUBMISSION OF APPLICATION

COLLEGE / UNIVERSITY ATTENDED DATE GRADUATED
HOW DID YOU HEAR ABOUT THIS POSITION? (CHECK ONE)

JOB FAIR RECRUITMENT WORKSHOP
NEWSPAPER AD SCHOOL DISTRICT JOB FLYER
PAREAP SCHOOL DISTRICT WEB SITE
RECRUITER TEACHERS-TEACHERS.COM
OTHER (Please specify) CURRENT SCHOOL DISTRICT EMPLOYEE (Referred by)
_______________________________ Name:___________________________________ Position:___________________________
School or Location: ___________________________________________________________

YOU MUST SUBMIT THE ORIGINAL CRIMINAL RECORD CHECK AND PENNSYLVANIA CHILD ABUSE CLEARANCE AT THE TIME YOU ARE
OFFERED EMPLOYMENT. THOSE CANDIDATES RESIDING OUTSIDE OF PENNSYLVANIA OR WITH LESS THAN TWO YEARS PENNSYLVANIA
RESIDENCY MUST PRESENT A VALID FBI CRIMINAL CHECK. THESE DOCUMENTS ARE VALID FOR ONE YEAR AFTER THE DATE OF
ISSUANCE. YOU CANNOT BE APPOINTED UNLESS YOU PRESENT THE ORIGINAL DOCUMENTS AT THAT TIME.

1. POSITION TITLE APPLIED FOR:

2. LAST NAME FIRST NAME M.I.

3. ARE YOU PROFICIENT IN ANY OTHER DID YOU STUDENT TEACH WITH THE
LANGUAGE: SCHOOL DISTRICT OF PHILADELPHIA?
WORLD LANGUAGE BESIDES ENGLISH?
READ WRITE SPEAK SCHOOL: ______________________________

4. ARE YOU CURRENTLY EMPLOYED BY THE SCHOOL DISTRICT OF PHILADELPHIA? FROM:______________ TO: _______________
YES, IF YES, CHECK ONE NO NAME OF COOPERATING TEACHER(S)
LONG-TERM SUBSTITUTE
REGULAR APPOINTMENT PER DIEM SUBSTITUTE _______________________________________
PROVISIONAL APPOINTMENT APPRENTICE / LITERACY INTERN _______________________________________
5. HAVE YOU EVER BEEN EMPLOYED BY THE SCHOOL DISTRICT OF PHILADELPHIA? YES NO

IF “YES”, DATES OF EMPLOYMENT: FROM TO
REASON FOR LEAVING:

FOR OFFICE USE ONLY
ONLY
SCORE RANK SAD PPAD APPROVED DISAPPROVED

CONDITIONAL ADMISSION

TIE BROKEN BY:

DATE INITIALS
REMARKS:

SEH - 430 (10/03) Cover
STANDARD APPLICATION
for Teaching Positions in
Pennsylvania Public Schools
(Please Type or Print)
POSITION(S) DESIRED__________________________________________________________

Name__________________________________________________________________________
Last First Middle Social Security Number1

Present Address_______________________________________(____)_____________________
Street Telephone
_______________________________________________________________________________
City State Zip

Permanent Address_____________________________________(____)_____________________
Street Telephone
____________________________________________________________________________
City State Zip

E-mail Address (if available___________________________________________

List, in order of preference, the grades, subjects and/or positions for which you are applying:

1.________________________ 2.________________________ 3.__________________________

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
schools.)

Area of Certification Issuing Date
State Issued

Have you acquired tenure in Pennsylvania?_________. If yes, in what school district?_____________

_______________________________________________________________________________

Date available for employment___________________________

If you are not employed full time, are you interested in being placed on our Substitute List? ❑ Yes ❑ No
Long-term ❑ Yes ❑ No Short-term ❑ Yes ❑ No

1
Federal Privacy Act [5 U.S. C. § 552a note] Statement. Authority for requesting social security account numbers:, Public School Code of 1949 [24 P.S. § 12-1212,
24 P.S. § 1224] Principal Purpose: To verify certification. Other Purposes: Identification and collection of criminal/disciplinary records for certified educators.
Disclosure: Mandatory. Failure to provide the SSAN will result in an applicant not being considered for employment.

PDE-353A (effective 3/1/99)
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