Part I	Opp City Schools Certified Application Opp City Schools P.O. Box 840 Opp, Alabama 36467 (334) 493-3173 Please fill in all fields. Legal Name:   Date: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Street Address: City & State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY Zip: Phone:   E-mail: Click the TABS on the left to continue. Please fill in all fields. Major Teaching Field(s): Certificate: Type 'B' Type 'A' Type 'AA'   Issue Date: Expiration Date: Position for which you are applying: Are you under contract now? No Yes   If yes, with what system? Have you ever been discharged from a position? No Yes   If yes, when? Please list all colleges and universities attended. Following is a list of Alabama degree-granting institutions of higher education. If your school is not listed, please select Other at bottom and fill in at right. 1. Select below: Four-year public (state) universities Alabama A & M University Alabama State University Auburn University Auburn University Montgomery Jacksonville State University Troy State University Troy State University Dothan Troy State University Montgomery University of Alabama University of Alabama at Birmingham University of Alabama at Huntsville University of Montevallo University of North Alabama University of South Alabama University of West Alabama Four-year private, nonprofit colleges and universities Birmingham-Southern College Concordia College Faulkner University Heritage Christian University Huntingdon College Judson College Miles College Oakwood College Samford University Southeastern Bible College Spring Hill College Stillman College Talladega College Tuskegee University University of Mobile Two-year public colleges Athens State University Enterprise State Junior College Lurleen B. Wallace State Junior College Two-year private colleges Marion Military Institute United States Sports Academy Two-year public community colleges Alabama Southern Community College Bevill State Community College Bishop State Community College Calhoun Community College Centeral Alabama Community College Chattahoochee Valley Community College Jefferson Davis Community College James H. Faulkner State Community College Gadsden State Community College Jefferson State Community College Lawson State Community College Northeast Alabama State Community College Northwest-Shoals Community College Shelton State Community College Snead State Community College Southern Union State Community College Wallace Community College George C. Wallace Community College at Selma Wallace State College at Hanceville Two-year public technical colleges Harry M. Ayers State Technical College Bessemer State Technical College J. F. Drake State Technical College Douglas MacArthur State Technical College John M. Patterson State Technical College Reid State Technical College H. Councill Trenholm State Technical College Degree-granting proprietary (trade) schools Herzing College ITT Technical Institute Prince Institute of Professional Studies South College Southeast College of Technology Virginia College Other Other (fill in at right) None 2. Select below: Four-year public (state) universities Alabama A & M University Alabama State University Auburn University Auburn University Montgomery Jacksonville State University Troy State University Troy State University Dothan Troy State University Montgomery University of Alabama University of Alabama at Birmingham University of Alabama at Huntsville University of Montevallo University of North Alabama University of South Alabama University of West Alabama Four-year private, nonprofit colleges and universities Birmingham-Southern College Concordia College Faulkner University Heritage Christian University Huntingdon College Judson College Miles College Oakwood College Samford University Southeastern Bible College Spring Hill College Stillman College Talladega College Tuskegee University University of Mobile Two-year public colleges Athens State University Enterprise State Junior College Lurleen B. Wallace State Junior College Two-year private colleges Marion Military Institute United States Sports Academy Two-year public community colleges Alabama Southern Community College Bevill State Community College Bishop State Community College Calhoun Community College Centeral Alabama Community College Chattahoochee Valley Community College Jefferson Davis Community College James H. Faulkner State Community College Gadsden State Community College Jefferson State Community College Lawson State Community College Northeast Alabama State Community College Northwest-Shoals Community College Shelton State Community College Snead State Community College Southern Union State Community College Wallace Community College George C. Wallace Community College at Selma Wallace State College at Hanceville Two-year public technical colleges Harry M. Ayers State Technical College Bessemer State Technical College J. F. Drake State Technical College Douglas MacArthur State Technical College John M. Patterson State Technical College Reid State Technical College H. Councill Trenholm State Technical College Degree-granting proprietary (trade) schools Herzing College ITT Technical Institute Prince Institute of Professional Studies South College Southeast College of Technology Virginia College Other Other (fill in at right) None 3. Select below: Four-year public (state) universities Alabama A & M University Alabama State University Auburn University Auburn University Montgomery Jacksonville State University Troy State University Troy State University Dothan Troy State University Montgomery University of Alabama University of Alabama at Birmingham University of Alabama at Huntsville University of Montevallo University of North Alabama University of South Alabama University of West Alabama Four-year private, nonprofit colleges and universities Birmingham-Southern College Concordia College Faulkner University Heritage Christian University Huntingdon College Judson College Miles College Oakwood College Samford University Southeastern Bible College Spring Hill College Stillman College Talladega College Tuskegee University University of Mobile Two-year public colleges Athens State University Enterprise State Junior College Lurleen B. Wallace State Junior College Two-year private colleges Marion Military Institute United States Sports Academy Two-year public community colleges Alabama Southern Community College Bevill State Community College Bishop State Community College Calhoun Community College Centeral Alabama Community College Chattahoochee Valley Community College Jefferson Davis Community College James H. Faulkner State Community College Gadsden State Community College Jefferson State Community College Lawson State Community College Northeast Alabama State Community College Northwest-Shoals Community College Shelton State Community College Snead State Community College Southern Union State Community College Wallace Community College George C. Wallace Community College at Selma Wallace State College at Hanceville Two-year public technical colleges Harry M. Ayers State Technical College Bessemer State Technical College J. F. Drake State Technical College Douglas MacArthur State Technical College John M. Patterson State Technical College Reid State Technical College H. Councill Trenholm State Technical College Degree-granting proprietary (trade) schools Herzing College ITT Technical Institute Prince Institute of Professional Studies South College Southeast College of Technology Virginia College Other Other (fill in at right) None 4. Select below: Four-year public (state) universities Alabama A & M University Alabama State University Auburn University Auburn University Montgomery Jacksonville State University Troy State University Troy State University Dothan Troy State University Montgomery University of Alabama University of Alabama at Birmingham University of Alabama at Huntsville University of Montevallo University of North Alabama University of South Alabama University of West Alabama Four-year private, nonprofit colleges and universities Birmingham-Southern College Concordia College Faulkner University Heritage Christian University Huntingdon College Judson College Miles College Oakwood College Samford University Southeastern Bible College Spring Hill College Stillman College Talladega College Tuskegee University University of Mobile Two-year public colleges Athens State University Enterprise State Junior College Lurleen B. Wallace State Junior College Two-year private colleges Marion Military Institute United States Sports Academy Two-year public community colleges Alabama Southern Community College Bevill State Community College Bishop State Community College Calhoun Community College Centeral Alabama Community College Chattahoochee Valley Community College Jefferson Davis Community College James H. Faulkner State Community College Gadsden State Community College Jefferson State Community College Lawson State Community College Northeast Alabama State Community College Northwest-Shoals Community College Shelton State Community College Snead State Community College Southern Union State Community College Wallace Community College George C. Wallace Community College at Selma Wallace State College at Hanceville Two-year public technical colleges Harry M. Ayers State Technical College Bessemer State Technical College J. F. Drake State Technical College Douglas MacArthur State Technical College John M. Patterson State Technical College Reid State Technical College H. Councill Trenholm State Technical College Degree-granting proprietary (trade) schools Herzing College ITT Technical Institute Prince Institute of Professional Studies South College Southeast College of Technology Virginia College Other Other (fill in at right) None Please fill in all fields. Student Teaching Location:   Dates: Supervising Teacher:   Number: Teaching Experience (Chronologically from earliest job): School Date from-Date to Position Reason for leaving 1. 2. 3. 4. Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which have not been annulled, expunged, or sealed by a court? (If yes, attach a sheet describing in full) No      Yes Please read the following information carefully. You—the applicant—are responsible for adhering to the following guidelines. A false answer to any portion of this application may invalidate contract. I understand that this application is valid for three years from the date of completion. At that time, it is my responsibility to complete a new application to receive consideration. I understand that my application will be discarded after it has become inactive. I certify that the answers given by me in this application are true and correct without omissions of any kind. I agree that the school system shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this application. I authorize the Opp City Schools to make any investigation of my personal or employment history and authorize any former employer, person, firm, corporation, or governmental agency to disclose to the school district any information they have regarding me. In consideration of the school district's review of this application, I hereby release the district as well as all providers of information from any liability and for any damage that may result from the furnishing and receiving of this information. A copy of this authorization and release is as valid as the original and should be recognized as such. I understand that if I am recommended for a position, the Alabama State Department of Education will require me to submit a completed background check packet and fees. The cost of this background check is $49.00. I have read and understand the guidelines above and agree to abide by them.   Clear
Part II
Part III
Part IV
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