"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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New Jersey Department of Education
Office of Certification and Induction
Data Sheet for Career and Technical Education (CTE) Licensure
To be completed by the applicant. All documents must be sent directly from the applicant to
CertApplication@doe.nj.gov
with the applicant’s Teacher Certification Information System (TCIS) Tracking Number in the subject line of the email.
Candidate Contact Information
Information submitted should match all other required documentation.
Last Name:
First Name:
Middle Name or Initial:
Street Address:
City:
State:
Zip Code:
Last Four Digits of Social Security Number: ***-**-
Email Address:
Tracking Number (If Known):
Date of Birth (mm/dd/yyyy):
Phone Number:
CTE Certification Endorsement Area Requested:
Education and Training
1. High School
Name of High School:
Location:
Course:
Dates Attended (mm/yyyy):
to
Did you graduate? Yes
No
2. College or University
Name of College or University:
Location:
Major:
Minor:
Credit Hours Completed:
Dates Attended (mm/yyyy):
to
Degree:
Date Degree Conferred:
3. Graduate School
Name of Graduate School:
Location:
Major Area of Study:
Credit Hours Completed:
Dates Attended (mm/yyyy):
to
Degree:
Date Degree Conferred:
Page 1 of 4
New Jersey Department of Education
Office of Certification and Induction
Data Sheet for Career and Technical Education (CTE) Licensure
To be completed by the applicant. All documents must be sent directly from the applicant to
CertApplication@doe.nj.gov
with the applicant’s Teacher Certification Information System (TCIS) Tracking Number in the subject line of the email.
Candidate Contact Information
Information submitted should match all other required documentation.
Last Name:
First Name:
Middle Name or Initial:
Street Address:
City:
State:
Zip Code:
Last Four Digits of Social Security Number: ***-**-
Email Address:
Tracking Number (If Known):
Date of Birth (mm/dd/yyyy):
Phone Number:
CTE Certification Endorsement Area Requested:
Education and Training
1. High School
Name of High School:
Location:
Course:
Dates Attended (mm/yyyy):
to
Did you graduate? Yes
No
2. College or University
Name of College or University:
Location:
Major:
Minor:
Credit Hours Completed:
Dates Attended (mm/yyyy):
to
Degree:
Date Degree Conferred:
3. Graduate School
Name of Graduate School:
Location:
Major Area of Study:
Credit Hours Completed:
Dates Attended (mm/yyyy):
to
Degree:
Date Degree Conferred:
Page 1 of 4
4. Other Formal Training (Including Military)
Name of Training:
Dates Attended(mm/yyyy):
to
Did you complete the Training? Yes
No
Description of Training:
5. Other Formal Training (Including Military)
Name of Training:
Dates Attended (mm/yyyy):
to
Did you complete the Training? Yes
No
Description of Training:
Employment
Begin with your most recent employer first. Include military service. If necessary, use additional sheets.
1. Present or Most Recent Employer
Name:
Address:
Name and title of immediate supervisor:
Title of your position:
Dates in this position (mm/yyyy):
to
Part Time
Full Time
Describe in detail your duties (include any machinery or equipment operated)
2. Employer
Name:
Address:
Name and title of immediate supervisor:
Title of your position:
Dates in this position (mm/yyyy):
to
Part Time
Full Time
Describe in detail your duties (include any machinery or equipment operated).
Page 2 of 4
3. Employer
Name:
Address:
Name and title of immediate supervisor:
Title of your position:
Dates in this position (mm/yyyy):
to
Part Time
Full Time
Describe in detail your duties (include any machinery or equipment operated).
4. Employer
Name:
Address:
Name and title of immediate supervisor:
Title of your position:
Dates in this position (mm/yyyy):
to
Part Time
Full Time
Describe in detail your duties (include any machinery or equipment operated).
References
List the names of at least three persons from whom we may request character references.
Reference 1
Name:
Occupation:
Telephone Number:
Address:
Reference 2:
Name:
Occupation:
Telephone Number:
Address:
Page 3 of 4
Reference 3
Name:
Occupation:
Telephone Number:
Address:
Reference 4 (Optional)
Name:
Occupation:
Telephone Number:
Address:
Form Verification
Applicant must agree to and sign below the following statement:
I certify that all statements and data contained on this document are true and accurate.
Electronic Signature of Applicant:
Date (mm/dd/yyyy):
Page 4 of 4