Certified Application

Certified Application

Application for Employment

Certified Positions


1. Name


2. Current Address
 Street/P.O. BoxCityStateZip

3. Telephone #         Cell Phone # 

4. E-mail Address 

5. Please list in order of preference the specific position or positions for which you are applying and are qualified:

  • A. 
  • B. 
  • C. 

6. Do you currently have a valid Arizona Teaching Certificate?   Yes   No

   List the type(s), including out of state certifications.

StateCertificate TypeEndorsementsExp. Date


7. Have you ever interviewed, worked or volunteered for the Bullhead City Elementary School District?

Yes    No     If yes, give dates/position: 


8. Do you have any relatives or family nembers currently employed by the Bullhead City Elementary School District?

Yes  No      If yes, name(s)/position: 


9. Are you fluent in any languages other than English?  Yes   No

If yes, what language(s) do you speak/read/write? 


10. Education

Name of High SchoolLocaton (City, State)Diploma Attained


Colleges/Universities  (Undergraduate)

Location (City, State)Major/Minor

Diploma Attained


Colleges/Universities (Graduate)Location (City, State)Major/MinorDiploma Attained


11. Teaching Experience

Practice Teaching

Name of SchoolGrade or LocationSubject TaughtDates From-To


Full Time Teaching: List only contract teaching experience in public and private schools, colleges, or universities.

Name of SchoolLocationGrade or Subject TaughtDates From-ToReason for Leaving


12. Work Experience Other Than Teaching (List in order and account for all employment gaps.)

Employer's NameLocationPosition HeldDatesReason for Leaving


13. References List a minimumof three(3) principals, supervising teachers, or job supervisors.

NamePositionTelephone #E-Mail Address


14. Answering "Yes" to any of the following five (5) questions will not cecessarily result in denial of employment.  Your written explanation will assist the District in determining your eligibility and suitability for employment. If you answer "Yes" to any quesiton, you must provide a complete written account of the incident(s).

No  Yes   

Have you ever been convicted of, admitted committing, or are you awaiting trial for any crime (excluding only minor traffic viloations not involving any allegation of drug or alcohol impairment)?

No  Yes

Have you ever been dismissed (fired) from any job, or resigned at the request of your employer, or while charges against you or an investigation of your behavior was pending?  You must answer "Yes" even if the matter was resolved with any form of settlement or severance agreement, regardless of its terms.

No  Yes 

Have you ever had any license or certificate of any kind (teacher certificate or otherwise) revoked or suspended, or have you in any way been sanctioned by, or is any charge or complaint now pending against you before any licensing, certifcation or other regulatory agency or body, public or private?

No  Yes

Are you now being investigated for any alleged misconduct or other alleged grounds for discipline by any licensing, certification or other regulatory body (teacher certification or otherwise or by your current or any previous employer?

No  Yes

Have you ever been convicted of, admitted committing, or are you awaiting trial for any dangerous crime agains children as defined in ARS 13-604.01?

If you answered "Yes" to any quesiton, please provide a complete written account of the incident(s).



I authorize each person, school district, firm or corporation listed on my application to answer any questions they are asked and to give any information concerning this application including work habits, character or skills.  No  Yes


May we contact your current employer?   No  Yes


Every answer I have provided on this application is complete and truthful.  I understand and agree that:

1. If any information is omitted from or not filled in on this application, or if any false information is furnished, the District will reject my application.

2. If any information is false, I will be ineligible for future consideration for employment and may be subject to criminal prosecution.

3. If I am employed by the District, I may be dismissed from employment, criminally prosecuted, and if certified, my certificate may be revoked.

Agree  Do Not Agree


I understand, at the time of hire, I will be responsible for expenses incurred to complete fingerprinting and background investigation fees. Yes  No


Please Note: Bullhead City School District reserves the right to consider only the most qualified applications for each position.  Depending on the position requirements, all District employment is contingent upon the successful completion of a drug screen, medical evaluations, verification of previous employment, fingerprinting and criminal background checks through the Dept. of Public Safety and the Federal Bureau of Investigation.

Unless we are notified in writing to keep this application on file, it will be discarded after one year.


It is the policy of Bullhead City Elementary School District #15 not to discriminate on the basis of sex, race, color, creed, age, disability, political affiliation, marital status or national origin in its education programs, activities, or employment policies as required by Federal Law.

Compliance Officer:  Superintendent, Bullhead City Elementary School District #15
 1004 Hancock Rd.
 Bullhead City, AZ 86442
 (928) 758-3961


Professional Staff Hiring

Consent to Conduct Background Investigation and Release

I have applied for employment with Bullhead City School District to work.  I understand that in order for the School District to determine my eligibility, qualifications, and suitability for employment, the School District will conduct a background investigation to determine if I am to be considered for an offer of employment.  This investigation may include asking my current employer, any former employer, and any educational institution I have attended about my education, training, experience, qualifications, job performance, professional conduct, and evaluations, as well as confirming my dates of employment or enrollment, position(s) held, reason(s) for leaving employment, whether I could be rehired, reasoning for not rehiring (if applicable), and similar information.

I hereby give my consent for any employer or educational institution to release any information requested in connection with this background investigation.  Yes  No

According to the Family Educational Rights and Privacy Act, I understand that I have a right to see most education records that are maintained by any educational institution.
In light of the preceding paragraph, Iwaive / do not waive my right to see any written reference or other information provided to the School District by any educational institution.
According to Arizona Revised Statutes Section 23-1361, any employer that provides a written communication to the School District regarding my current or past employment must send me a copy at my last known address.  I acknowledge that some employers are unwilling to provide factual written references concerning a current or past employee unless they may do so confidentially, without revealing the references to the employee, and that the School District will not further consider my application if it cannot complete its background investigation.
In light of the preceding, Iwaive / do not waive my right to receive a copy of any written communication furnished to the School District by any employer.
Whether or not I have waived my right to see or to receive copies of written references furnished to the School District by employers or educational institutions, I release, hold harmless, and agree not to sue or file any claim of any kind against any current or former employer or educationa institution, and any officer or employee of either, that in good faith furnishes written or oral references requested by this School District to complete its background investigation.  Yes  No
I consent to have Bullhead City School District conduct a background investigation.
I do not consent to have Bullhead City School District conduct a background investigation.