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THE UNIVERSITY OF THE STATE OF NEW YORK/THE STATE EDUCATION DEPARTMENT
 ALBANY, NY 12234

                                                                                        

New York State Testing Program

Grades 3-8 English Language Arts and Mathematics

Recruitment Form

 

Please complete ALL information on this form in a Word document for E-mail.

Date: _________________


Name: ________________________________________________________________________
                        (Mr./Mrs./Ms.)                   (First)                                  (Last)

Home Address:_________________________________________________________________

City: ____________________________      State:  _________                    Zip: ___________   

Home/Cell Telephone: (____)______-____________

 

Gender:   Male_____     Female_____

 

School District:  ________________________________________________________________

School Name: __________________________________________________________________

Street: ________________________________________________________________________

City/Town: ____________________________       State:  New York   Zip: _________________

School Telephone: (____)___________-____________    

Name of Principal: _____________________________________________________________

Email Address (most frequently used):_ ________________@___________________________

Work Status:    Full Time_____                      Part Time_____
Retired_____             
Year you retired? ______

Check the region in which your
school is located.
                                                                                                   

  1. Long Island
  2. New York City                                                                                                                       
  3. Lower Hudson
  4. Mid-Hudson
  5. Capital District
  6. North Country/Adirondacks
  7. Central
  8. Western
  9. Southern Tier

 

 

 

  



Which of the following describes your race/ethnicity?  *

    1. Black
    2. Hispanic
    3. Native American/Alaskan Native
    4. White
    5. Asian and/Pacific Islander
    6. Other

 

*Please note: This information is used solely to ensure diversity in teacher representation on the Department committees.

 

New York State Certification(s):

  1. K-6     Subject area(s): _________________________________________
  2. 7-8       Subject area(s): _________________________________________
  3. 9-12     Subject area(s): _________________________________________
  4. other    Specify area(s):_________________________________________

 

Education:   B.A./B.S. _________    M.A./M.S. ______________ Other___________

Current Position: 

    1. Classroom Teacher Grade(s)_____________
    2. Classroom Teacher Subject Specialist Grade(s)____________
    3. Special Education Teacher Grade(s)_______________
    4. Bilingual/ELL Teacher Grade(s)_______________
    5. Curriculum/Specialist_____________
    6. Professional Development Specialist____________
    7. Director_______________
    8. Supervisor_______________
    9. School Administrator_______________
    10. Reading Teacher Grade(s)____________
    11. Reading Specialist Grade(s)____________

 

    1. Literacy Coach Grade(s)_______________
    2. Mathematics Coach Grade(s)_______________

 

  

 

 

 

 

 

 

 

 


Please indicate the content area for which you are interested in attending.  You must plan on attending ALL the days for the respective processes.

  1. English Language Arts                        
  2. Mathematics                           

 

 

Have you worked with the State Education Department before?  What experience have you had with test development tasks?  (i.e. item writing, item review, final eyes review, standard setting, and range finding)

 ______________________________________________________________________

______________________________________________________________________________
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______________________________________________________________________________
______________________________________________________________________________

______________________________________________________________________________

 

 

 

What other teaching experience do you have? (i.e. local or regional scorer, scoring leader, facilitator, curriculum writing, local level experience with test development) Please explain.

___________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

 

 

PROFESSIONAL REFERENCES

 

  1. __________________________________________________

__________________________________________________

__________________________________________________

              __________________________________________________

              __________________________________________________

 

 

2.          __________________________________________________
 
             __________________________________________________
             
             __________________________________________________
 
             __________________________________________________

             __________________________________________________

 

 

3.         __________________________________________________
             
             __________________________________________________
 
             __________________________________________________

             __________________________________________________

             __________________________________________________

 

Please return this form along with your resume` to the Office of State Assessment for English Language Arts or Mathematics.  You will be notified by e-mail if you have been selected to participate. Please e-mail your form to:  emscassessinfo@mail.nysed.gov.  If fax is more convenient for you, you may send to 518-402-5596.