REGIONAL APPLICANT DATA BANK

EASTERN SHORE OF MARYLAND EDUCATIONAL CONSORTIUM

The Eastern Shore of Maryland Educational Consortium represents the nine boards of education from the Eastern Shore. This regional applicant data bank form will provide applicant information to be shared with these school districts. Individual school districts may contact you about a vacancy. Please note that the data bank only includes applicants for the following areas: Occupational Therapy, Physical Therapy, Special Education, Speech Pathology, Media, Home Economics, Technology, Business Education, Foreign Languages, Mathematics and Sciences. Complete this form ONLY if you wish to make application in one of these areas as a part of the applicant data bank for the Eastern Shore of Maryland Educational Consortium. Other applicants should apply directly to the school districts.

All counties on the Eastern Shore of Maryland are equal opportunity employers.

Please provide the following contact information:

FIRST NAME:

M.I.:

LAST NAME:

SALUTATION:

HOME ADDRESS:

CITY:

STATE:

ZIP:

PHONE:

EMAIL:

SOCIAL SECURITY NUMBER:

CURRENT EMPLOYER:

DATE AVAILABLE FOR EMPLOYMENT:

LAST COLLEGE ATTENDED:

DEGREE AND DATE:

MAJOR:

POSITION DESIRED:

CERTIFICATION AREA(S):

The Eastern Shore of Maryland Educational Consortium
202 Chesterfield Avenue
Centreville, MD 21617

I authorize the Eastern Shore of Maryland Educational Consortium or the county board of education to which this information is submitted to include the above information in the Regional Applicant Data Bank and distribute copies to the nine Eastern Shore of Maryland school districts.. This information will be purged at the end of each school year.

Submittal of this form certifies that I agree with the above conditions.

FIRST NAME:
M.I.:
LAST NAME:
SALUTATION:
HOME ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
EMAIL:
SOCIAL SECURITY NUMBER:
CURRENT EMPLOYER:
DATE AVAILABLE FOR EMPLOYMENT:
LAST COLLEGE ATTENDED:
DEGREE AND DATE:
MAJOR:
POSITION DESIRED:
CERTIFICATION AREA(S):