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Special Education Case Manager Application Form

Please complete the form below. Required fields marked with an asterisk *
Contact Information
Address
State
Answer Required
Have you fulfilled the highly qualified requirements for the state of Colorado?*
Answer Required
Are you currently licensed to teach in any state?*
Answer Required
If yes, which state(s) and what type of licensure/certificate?
Answer Required
Do you hold a CDE-issued Special Education Generalist or Special Education Specialist license?*
Answer Required
If no, are you willing to enroll in an alternative teacher licensure program or an accredited Colorado university special education program?
Answer Required

Please list the level(s) and area(s) of endorsement (Major/Minor) on your certificate/license. Please refer directly to your license for this information.

Have you ever voluntarily surrendered or had revoked any license/certificate to teach?*
Answer Required

Personal References

Please list the names of four professional references. These should be professionals with detailed knowledge of your education/administrative abilities. Please include at least one supervisor. College professors/advisors are appropriate references.

First Reference

Second Reference

Third Reference

Fourth Reference

Teaching Preferences

Please indicate your desired work status:*
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Work Experience

Please list your most recent experience first.

Are you currently employeed with this organization?*
Answer Required

Address of Organization

State*
Answer Required

Please list your second most recent employment.

Address
State
Answer Required

Background Report

Due to the responsibility Caprock Academy has to its school children and community, the following information is needed from all applicant and employees regarding convictions. A record of conviction does not necessarily prohibit employment. Failure to complete this form accurately and completely may mean disqualification from consideration for employment, and may be cause for consideration of dismissal if employed, and may result in prosecution for filing false information with a public agency. Applicants and employees must report any convictions that occur subsequent to the time they initially complete this form. Questions regarding this information should be directed in email to: [email protected]

Please read carefully and answer every question by clicking the appropriate box. If you answer YES to any of the questions below, please explain in detail on a separate document, referring to the specific question.

1. Have you ever been convicted* of a felony?*
Answer Required
2. Have you ever been convicted* of a misdemeanor, other than minor traffic violations?*
Answer Required
3. Have you ever been convicted* of a sex or drug related offense?*
Answer Required
4. Has any court ever received a plea of guilty or a plea of nolo contendere from you or any offense or has any court deferred further proceedings without entering a plea of guilty?*
Answer Required
5. Have you ever been placed on probation?*
Answer Required
6. Have you ever been convicted* of, plead nolo contendere to, or received a deferred sentence for a crime involving unlawful behavior involving a child?*
Answer Required
7. Have you ever been dismissed or have you resigned from a position as a result of an allegation of unlawful behavior involving a child, including unlawful sexual behavior?*
Answer Required
8. Have you ever had any professional licenses (including teaching certificates/licenses) suspended, annulled, or revoked in any state or country?*
Answer Required
10. Have you ever been involuntarily terminated from any employment or asked to resign from employment?*
Answer Required
11. Have you ever been non-renewed or refused a continuing contract?*
Answer Required

*CONVICTION means the final judgment on a verdict or a finding of guilty, a plea of guilty, or a plea of nolo contendere in any state or federal court of competent jurisdiction in a criminal case, regardless of whether an appeal is pending or could be taken. Conviction does not include a final judgment which has been expunged by pardon, reversed, set aside, or otherwise rendered invalid.

Upload your resume, letters of recoomendation, and transcripts prior to submitting.*
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or drag it here.
Could you please share with us how you learned about this job opportunity?*
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Applicant Signature

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge. I agree to have any of the information checked by Caprock Academy. I authorize the references listed, as well as any other individuals whom Caprock Academy contacts (including my current employer, former employers, and any government or law enforcement agency)to provide Caprock Academy any and all information concerning my previous or current employment. I understand that if I limit Caprock Academy’s right to contact persons/organizations deemed necessary by Caprock Academy, the application may not be considered further. Also, I release all parties and persons from any and all liability for any damages that may result as a consequence of furnishing such information to Caprock Academy or any of its agents, employees, or representatives for purposes related to this application and my employment. I agree that with or without an accommodation, I must be able to perform the “essential functions” of the position. If an accommodation is required, I must make that request prior to my employment start date. I understand that ANY misrepresentation, falsification, or material omission of information during the interview or on this application, may result in my failure to receive an offer of
employment, OR, IF I AM HIRED, MAY RESULT IN MY EMPLOYMENT BEING TERMINATED by Caprock Academy. I understand that any results of the Colorado Bureau of Investigation/Federal Bureau of Investigation background checks which might deny me employment will be forwarded to the Colorado Department of Education. I understand applications are kept on file for a period of one year and will remain the property of Caprock Academy.

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