Instructions:
Application for Certified Staff.

This document is in Microsoft Word format. It has been formatted to include entry fields for each of the responses on the form. The document is protected to prohibit changing any of the form’s content. To enter your information, click where your last name is to be entered. A dark area should appear to indicate that you are entering your information at the correct spot. Enter your last name, then tab to the next field. Continue entering information and tabbing to the next field until the form is complete. When complete, either mail the form or attach it to an email message. Emailed documents may be signed if and when you are scheduled for an interview.

Address for U.S. mail:

Mrs. Julia Becich
Lake Zurich Community Unit School District 95
400 S. Old Rand Road
Lake Zurich, IL 60047

Address for email:
HumanResources@lz95.org
Community Unit School District 95
Administration Center
400 S. Old Rand Road
Lake Zurich, IL  60047

APPLICATION
CERTIFIED STAFF

You are not required to furnish any information which is prohibited by federal, state or local law.
Community Unit School District No. 95 does not discriminate against any individual because of his or her race, color, religion, sex, national origin, ancestry, age, marital status, physical or mental handicap, military status, or unfavorable discharge from military service in connection with employment, real estate transactions, access to financial credit, and the availability of public accommodations.  Any individuals requiring special accommodations in the application process should contact the District’s ADA/Section 504 coordinator. Community Unit School District No. 95 is an equal opportunity employer.
Date: April 30, 2003

Name 	WATERS	KAYLA	JOY	
	Last	First	Middle
Present Address	234 SUNNYRIDGE CT. APT. C8		
	Number/Street
	PEKIN	IL	61554	Telephone	(309) 346-5178	
	City	State	Zip
Social Security Number: 	335-80-2851	
Illinois Teaching Certificate	 Yes	 No	 Applied for
Type	9	 No._	1896595	Type		   	 No.	     	
Type	   	 No._	     	Type		   	 No.	     	
PROFESSIONAL PREPARATION - College or University Attended
Name & Location	Dates Attended	Degree/Date	Major/Minor	Semester Hours	
Illinois State University Normal, IL	8/1998-12/2001	Bachelor of Science
December 2001	Social Science Education/
Political Science	100/18	
Illinois Central College
East Peoria, IL	8/1997-5/1998	N/A	General	32	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	

Page 2

Please list any specialized courses that you have taken which would be especially helpful in this teaching position (e.g. reading, values, careers, individualized instruction, computer applications or combination.)
United States History to 1865, Unites States History Since 1865, Unites States History 1945 to Present, 	
     	
     	
     	
PROFESSIONAL EDUCATION EXPERIENCE

PLEASE GIVE FULL AND ACCURATE DATA REGARDING YOUR EDUCATIONAL EXPERIENCE, INCLUDING STUDENT TEACHING.  LIST YOUR PRESENT OR MOST RECENT POSITION FIRST.
Dates: From/To	Name of School
City, State	Subject(s) and/or Grade Taught	Supervisor	Reason for Leaving	
10/2002-6/2003	Wilson Intermediate School
Pekin, IL	Permanent Substitute
Grades 4-6	Linda Harris
(309) 477-4722	Seeking full-time position	
1/2002-5/2002	Various Schools in Tazewell County	Substitute Teacher
Primarily grades 7-12	     	     	
10/2001-12/2001	Morton High School
Morton, IL	Geography and American Studies
9-12	Donald Sturm
(309) 266-7182	End of student teaching	
     	     	     	     	     	
     	     	     	     	     	

TEACHING AND/OR GRADE ASSIGNMENT PREFERENCE (List order preferred):
1.	United States History	
2.	World History	
3.	Civics/Government	
EXTRACURRICULAR INTERESTS
Please list extracurricular activities that you are willing to direct, supervise or coach:
Softball	
Track	
Cheerleading	
Student Council	
Yearbook	

Page 3

JOB EXPERIENCE OTHER THAN TEACHING
List here in chronological order all practical experience other than teaching, including trade or other  business experience; travel; social work; work in summer camps; youth activities; military.

Name and 
Address of  Employer	Dates	Position/Duties/Salary	Supervisor	Reason for Leaving	
The Company; Dance, Tumbling and Fine Arts	8/2001-	Tumbling Instructor and Coach of Team/ Responsible for instructing tumbling and trampoline classes/$15 and hr.	Jill Crouch and Nina Butler
(309) 925-4005	Currently Employed	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	

REFERENCES:	Give names of those who have observed and know your work:
Name	Address	Phone	Position	Relationship to Applicant	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	

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IF YOU ARE APPLYING FOR A POSITION AS AN ELEMENTARY SCHOOL TEACHER, PLEASE ANSWER:
1.	Explain what characteristics/qualities you have that would make you a good teacher.
     	
2.	In what ways do you want to impact students??
     	
3.	What types of instructional strategies would you utilize to be an effective teacher?.
     	
4.	Explain why you would like to be a teacher.
     	
5.	What do you see as the biggest challenges in education today?
     	
IF YOU ARE APPLYING FOR A POSITION AS A MIDDLE SCHOOL TEACHER, PLEASE ANSWER:
6.	What do you see as the most important aspects of the middle school philosophy?
     	
7.	What experience do you have with these aspects?
     	
8.	Discuss what experience you have with teaming within the middle school, and what qualities you feel you can bring to a team.
     	

IF YOU ARE APPLYING FOR A POSITION AS A HIGH SCHOOL TEACHER, PLEASE ANSWER:
1.	What contributions can you make to the intellectual development of students?
     	
2.	Describe your style of teaching, and how does it enhance student learning?
     	

IF YOU ARE APPLYING FOR A POSITION AS A SPECIAL EDUCATION TEACHER, PLEASE ANSWER:
1.	Describe your communication skills with parents, staff and students:
     	
2.	How do you prepare for annual reviews?
     	
3.	With what assessment tools are you most familiar? (Standardized, Curriculum Based, etc.)
     	
4.	Briefly describe the EDC (MDC) /IEP process.
     	

Page 5
APPLICANT’S AUTHORIZATION FOR INITIATION OFCRIMINAL BACKGROUND INVESTIGATION
I understand that I am subject to a criminal background investigation in accordance with Illinois law.  I further understand that I may be subject to immediate termination if the investigation discloses a conviction of certain specified criminal or drug offenses under Section 5/10-21.9 of The School Code.  I hereby authorize the District to initiate a criminal background investigation by the Illinois Department of State Police and agree to execute any forms required for such investigation.  I hereby warrant that I have not been convicted of any criminal offense specified in Section 10-21.9 of the Illinois School Code ILCS 5/10-21.9*
SIGNATURE FOR AUTHORIZATION FOR INITIATION OF CRIMINAL BACKGROUND INVESTIGATION
			
Signature of Applicant	Date
* Listed offenses under the Illinois School Code, Section 10-21.9:  First degree murder, attempted first degree murder; class X felony; indecent solicitation of a child; public indecency; prostitution; soliciting for a prostitute; soliciting for a juvenile prostitute; pandering; keeping a place of prostitution; patronizing a prostitute; pimping; juvenile pimping; exploitation of a child; obscenity; child pornography; harmful material distribution; criminal sexual assault; aggravated criminal sexual assault; violation of the Cannabis Control Act; and violation of the Illinois Controlled Substances Act.
PLEASE READ AND SIGN:
Failure to provide requested employment of employer history which is material to the applicant’s qualifications for employment or the provision of false statements or statements which the applicant does not believe to be true may be a Class A misdemeanor.
A person who makes a statement that he or she does not believe to be true or who knowingly omits or fails to include any employment history or employer required to be furnished on this application which is material to his or her qualification for employment shall be deemed to have made a false statement on his or her application.
I hereby certify that the statements in this application are true and to the best of my knowledge and belief.  I acknowledge that if I am employed and it is later determined that false or inaccurate information has been supplied on this application or during the interview process, I am subject to immediate dismissal.
I authorize the release and full disclosure of any and all information that you have concerning me, including information of a confidential or privileged nature, to any duly authorized agent of Community Unit School District 95.  I hereby release you, your organization or others from liability or damage which may result from furnishing the information.  A copy of this authorization and release is as valid as the original and should be recognized as such. 
			
Signature of Applicant	Date