"Data Sheet for Career and Technical Education (Cte) Licensure" - New Jersey

Data Sheet for Career and Technical Education (Cte) Licensure is a legal document that was released by the New Jersey Department of Education - a government authority operating within New Jersey.

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DATA SHEET FOR CAREER AND TECHNICAL EDUCATION (CTE) LICENSURE
STATE OF NEW JERSEY
DEPARTMENT OF EDUCATION
OFFICE OF CERTIFICATION AND INDUCTION
PO BOX 500
TRENTON, NJ 08625-0500
INSTRUCTIONS: TO BE COMPLETED BY THE APPLICANT. TYPE OR PRINT CLEARLY IN INK. ANSWER EACH
ITEM. SIGN YOUR NAME AND INSERT DATE ON REVERSE SIDE.
1. APPLICANT INFORMATION:
NAME: (LAST)
(FIRST)
(M.I.)
(MAIDEN NAME)
HOME ADDRESS:
APT.:
CITY:
STATE:
ZIP CODE:
SOCIAL SECURITY NUMBER:
HOME TELEPHONE NUMBER:
WORK TELEPHONE NUMBER:
CTE LICENSE REQUESTED:
2. EDUCATION AND TRAINING:
HIGH SCHOOL (NAME AND LOCATION)
COURSE:
DATES ATTENDED:
DID
YOU
GRADUATE:
FROM______ TO______
YES
NO
COLLEGE OR UNIVERSITY (NAME AND LOCATION)
MAJOR:
DATES ATTENDED:
DEGREE
AND
DATE:
FROM ________ TO________
________________
MINOR:
CREDIT HOURS
COMPLETED:
____________
MAJOR AREA OF
CREDIT HOURS
DEGREE(S) AND
GRADUATE SCHOOL (NAME AND LOCATION)
STUDY:
COMPLETED: ____________
DATE(S):
________________
_______________
DATES ATTENDED:
FROM _______ TO _________
DATES ATTENDED:
COMPLETED?
)
OTHER FORMAL TRAINING (INCLUDE MILITARY
FROM____________ TO _______________
YES
NO
DESCRIPTION OF TRAINING:
OVER
DATA SHEET FOR CAREER AND TECHNICAL EDUCATION (CTE) LICENSURE
STATE OF NEW JERSEY
DEPARTMENT OF EDUCATION
OFFICE OF CERTIFICATION AND INDUCTION
PO BOX 500
TRENTON, NJ 08625-0500
INSTRUCTIONS: TO BE COMPLETED BY THE APPLICANT. TYPE OR PRINT CLEARLY IN INK. ANSWER EACH
ITEM. SIGN YOUR NAME AND INSERT DATE ON REVERSE SIDE.
1. APPLICANT INFORMATION:
NAME: (LAST)
(FIRST)
(M.I.)
(MAIDEN NAME)
HOME ADDRESS:
APT.:
CITY:
STATE:
ZIP CODE:
SOCIAL SECURITY NUMBER:
HOME TELEPHONE NUMBER:
WORK TELEPHONE NUMBER:
CTE LICENSE REQUESTED:
2. EDUCATION AND TRAINING:
HIGH SCHOOL (NAME AND LOCATION)
COURSE:
DATES ATTENDED:
DID
YOU
GRADUATE:
FROM______ TO______
YES
NO
COLLEGE OR UNIVERSITY (NAME AND LOCATION)
MAJOR:
DATES ATTENDED:
DEGREE
AND
DATE:
FROM ________ TO________
________________
MINOR:
CREDIT HOURS
COMPLETED:
____________
MAJOR AREA OF
CREDIT HOURS
DEGREE(S) AND
GRADUATE SCHOOL (NAME AND LOCATION)
STUDY:
COMPLETED: ____________
DATE(S):
________________
_______________
DATES ATTENDED:
FROM _______ TO _________
DATES ATTENDED:
COMPLETED?
)
OTHER FORMAL TRAINING (INCLUDE MILITARY
FROM____________ TO _______________
YES
NO
DESCRIPTION OF TRAINING:
OVER
2
3.
PREVIOUS EMPLOYMENT: (BEGIN WITH YOUR LAST EMPLOYER FIRST.
INCLUDE MILITARY SERVICE) IF
NECESSARY, USE ADDITIONAL SHEETS.
NAME AND ADDRESS - PRESENT OR LAST EMPLOYER:
DESCRIBE
IN
DETAIL
YOUR
DUTIES
(INCLUDE
ANY
MACHINERY OR EQUIPMENT OPERATED)
NAME AND TITLE OF IMMEDIATE SUPERVISOR:
TITLE OF YOUR POSITION:
DATES IN THIS POSITION (MONTH AND YEAR):
FROM_________ TO ___________
PART TIME
FULL
TIME
NAME AND ADDRESS OF EMPLOYER:
DESCRIBE
IN
DETAIL
YOUR
DUTIES
(INCLUDE
ANY
MACHINERY OR EQUIPMENT OPERATED)
NAME AND TITLE OF IMMEDIATE SUPERVISOR:
TITLE OF YOUR POSITION:
DATES IN THIS POSITION (MONTH AND YEAR):
FROM_________ TO ___________
PART TIME
FULL
TIME
NAME AND ADDRESS OF EMPLOYER:
DESCRIBE
IN
DETAIL
YOUR
DUTIES
(INCLUDE
ANY
MACHINERY OR EQUIPMENT OPERATED)
NAME AND TITLE OF IMMEDIATE SUPERVISOR:
TITLE OF YOUR POSITION:
DATES IN THIS POSITION (MONTH AND YEAR):
FROM_________ TO ___________
PART TIME
FULL
TIME
NAME AND ADDRESS OF EMPLOYER:
DESCRIBE
IN
DETAIL
YOUR
DUTIES
(INCLUDE
ANY
MACHINERY OR EQUIPMENT OPERATED)
NAME AND TITLE OF IMMEDIATE SUPERVISOR:
TITLE OF YOUR POSITION:
DATES IN THIS POSITION (MONTH AND YEAR):
FROM_________ TO ___________
PART TIME
FULL
TIME
4.
REFERENCES; LIST BELOW THE NAMES OF AT LEAST THREE PERSONS FROM WHOM WE MAY REQUEST CHARACTER
REFERENCES.
NAME/TELEPHONE
ADDRESS
OCCUPATION
I CERTIFY THAT ALL STATEMENTS AND DATA ARE TRUE AND ACCURATE.
APPLICANT SIGNATURE ______________________________________________ DATE _____________________________
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