RETIRED TEACHER/ADMINISTRATOR 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.

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

Please provide the following contact information:

FIRST NAME:

M.I.:

LAST NAME:

STREET ADDRESS:

CITY:

STATE:

ZIP:

COUNTY:

HOME PHONE:

WORK PHONE:

EMAIL:

CURRENT EMPLOYER:

POSITION(S) DESIRED:

DATE AVAILABLE FOR EMPLOYMENT:

POSITION AT RETIREMENT:

RETIREMENT DATE:

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:
STREET ADDRESS:
CITY:
STATE:
ZIP:
COUNTY:
HOME PHONE:
WORK PHONE:
EMAIL:
CURRENT EMPLOYER:
POSITION(S) DESIRED:
DATE AVAILABLE FOR EMPLOYMENT:
POSITION AT RETIREMENT:
RETIREMENT DATE: