1) Have you ever had adverse action taken against any application, certificate, or license is any state? Adverse action includes the following: letter of warning, reprimand, denial, suspension, revocation, voluntary surrender or cancellation.

2) Have you ever been disciplined, reprimanded, suspended, or discharged from any employment because of allegations of misconduct?

3) Have you ever resigned, entered into a settlement agreement, or otherwise left employment as a result of alleged misconduct?

4) Is any action now pending against you for alleged misconduct in any school district, court, or before any educator-licensing agency?

5) Have you ever been charged with or convicted with or under indictment for a felony?*

6) Have you ever been charged with or convicted of a misdemeanor? (For the purpose of this application, minor traffic violations should not be reported)  Charges or convictions for driving while intoxicated (DWI) or driving under the influence of alcohol or other drugs (DUI) must be reported.*

* For a YES response to items 5 & 6, the following must be included: 1) Judgement Order -OR- 2) Final Order -OR- 3) Magistrate Court Documentation -AND- 4) all other relevant court documentation.