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I. General Information ID No.: 167
Document Created: July 28, 2000	Date Available: September 2000
Name: Teacher, IMA.
Social Security Number: 123-45-6789
Applicant Type: Teacher
Current Address: 555 Teacher Test
Teachertown, NY 10314	Phone: (718) 555-5785 Ext:
(e-mail): teachlg@aol.com
Permanent Address:
(Current Address is Permanent Address.)

II. Education and Professional Training ID No.: 167
Undergraduate Hours
Name of College or University	Location	Degree Received	Total Semester Hours	G.P.A. in Major	Cum. G.P.A.
1 St. Johns University	NY	BA	123.0	3.300	2.860

II. Education and Professional Training(continued) ID No.: 167
Graduate Hours
Name of College or University	Location	Degree Received	Total Semester Hours	G.P.A. in Major	Cum. G.P.A.
1 St. Johns University	NY	MST	60.0	0.000	3.800
2 ST. JOHNS UNIVERSITY	NY	MST	60.0	0.000	3.800

II. Education and Professional Training(continued) ID No.: 167
Test Scores
Date Taken	Test Name	Score
1 June 1995	NYSTCE-Liberal Arts and Sciences Test (LAST)	223
2 November 1995	NYSTCE-Assessment of Teaching Skills-Written (ATS-W)	256
3 February 1996	Content Specialty Test (CST) - Elementary Education	223

III. Educational Certification ID No.: 167
New York Teaching Certificates
Subject and Type	Expiration Date	Grade(s)
1  Subject:  Reading, PreK-12       Type:  Certificate of Qualification	February 1, 2003	PK - 12
2  Subject:  Special Education, PreK-12       Type:  Provisional Certificate	September 1, 2003	PK - 12
3  Subject:  Reading, PreK-12       Type:  Provisional Certificate	January 31, 2003	PK - 12
4  Subject:  Special Education, PreK-12       Type:  Provisional Certificate	January 1, 2003	PK - 12

III. Educational Certification (continued) ID No.: 167
Out of State Teaching Certificates
Subject and Type	State	Expiration Date	Grade(s)
None

IV. Employment History ID No.: 167
Prior Teaching Employment
Employer, Address, Phone	Position(s)	Dates	Years Full Time	Years Part Time
1 NYC BOARD OF EDUCATION SUBSTITUTE TEACHER ALL SCHOOLS DISTRICT 31 STATEN ISLAND, NY Phone: (718) 390-1647 Reason for Leaving: Left to Accept New Job	Elementary School Technology Ed. K-6	June 1996 - June 1998	0.0	0.0
2 NYC BOARD OF EDUCATION PS 57 STATEN ISLAND, NY 10304 Phone: (718) 477-1191 Reason for Leaving: (Does Not Apply)	Speech and Language Disorders	September 1998 - (Present)	2.0	0.0

IV. Employment History (continued) ID No.: 167
Other Employment
Employer, Address, Phone	Position	Dates
1 STATEN ISLAND ACADEMY STATEN ISLAND STATEN ISLAND, NY Phone: (000) 000-0000 Reason for Leaving: Left for Personal Reasons	Position: ALL GIRLS DIVISION HEAD SUMMER Duties: SUPERVISE GROUPS OF 1ST TO 6TH GRADE GIRLS	June 1995 - June 1996

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