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Text File  |  2007-05-07  |  50KB  |  1,145 lines
  1. <%
  2. ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit.
  3. On Error Resume Next
  4.  
  5. strErrorUrl = "error.htm"
  6.  
  7. If Request.ServerVariables("REQUEST_METHOD") = "POST" Then
  8. If Request.Form("VTI-GROUP") = "0" Then
  9.     Err.Clear
  10.  
  11.     Set fp_conn =  Server.CreateObject("ADODB.Connection")
  12.     FP_DumpError strErrorUrl, "Cannot create connection"
  13.  
  14.     Set fp_rs = Server.CreateObject("ADODB.Recordset")
  15.     FP_DumpError strErrorUrl, "Cannot create record set"
  16.  
  17.     fp_conn.Open Application("certified_ConnectionString")
  18.     FP_DumpError strErrorUrl, "Cannot open database"
  19.  
  20.     fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable
  21.     FP_DumpError strErrorUrl, "Cannot open record set"
  22.  
  23.     fp_rs.AddNew
  24.     FP_DumpError strErrorUrl, "Cannot add new record set to the database"
  25.     Dim arFormFields0(133)
  26.     Dim arFormDBFields0(133)
  27.     Dim arFormValues0(133)
  28.  
  29.     arFormFields0(0) = "CMin1"
  30.     arFormDBFields0(0) = "CMin1"
  31.     arFormValues0(0) = Request("CMin1")
  32.     arFormFields0(1) = "TeFrom3"
  33.     arFormDBFields0(1) = "TeFrom3"
  34.     arFormValues0(1) = Request("TeFrom3")
  35.     arFormFields0(2) = "RefPhone2"
  36.     arFormDBFields0(2) = "RefPhone2"
  37.     arFormValues0(2) = Request("RefPhone2")
  38.     arFormFields0(3) = "Street"
  39.     arFormDBFields0(3) = "Street"
  40.     arFormValues0(3) = Request("Street")
  41.     arFormFields0(4) = "Degree1"
  42.     arFormDBFields0(4) = "Degree1"
  43.     arFormValues0(4) = Request("Degree1")
  44.     arFormFields0(5) = "CMin2"
  45.     arFormDBFields0(5) = "CMin2"
  46.     arFormValues0(5) = Request("CMin2")
  47.     arFormFields0(6) = "NTEComp"
  48.     arFormDBFields0(6) = "NTEComp"
  49.     arFormValues0(6) = Request("NTEComp")
  50.     arFormFields0(7) = "TeAdd1"
  51.     arFormDBFields0(7) = "TeAdd1"
  52.     arFormValues0(7) = Request("TeAdd1")
  53.     arFormFields0(8) = "TeFrom4"
  54.     arFormDBFields0(8) = "TeFrom4"
  55.     arFormValues0(8) = Request("TeFrom4")
  56.     arFormFields0(9) = "RefPhone3"
  57.     arFormDBFields0(9) = "RefPhone3"
  58.     arFormValues0(9) = Request("RefPhone3")
  59.     arFormFields0(10) = "CDate1"
  60.     arFormDBFields0(10) = "CDate1"
  61.     arFormValues0(10) = Request("CDate1")
  62.     arFormFields0(11) = "Degree2"
  63.     arFormDBFields0(11) = "Degree2"
  64.     arFormValues0(11) = Request("Degree2")
  65.     arFormFields0(12) = "CMin3"
  66.     arFormDBFields0(12) = "CMin3"
  67.     arFormValues0(12) = Request("CMin3")
  68.     arFormFields0(13) = "NTEDate"
  69.     arFormDBFields0(13) = "NTEDate"
  70.     arFormValues0(13) = Request("NTEDate")
  71.     arFormFields0(14) = "CertEx"
  72.     arFormDBFields0(14) = "CertEx"
  73.     arFormValues0(14) = Request("CertEx")
  74.     arFormFields0(15) = "STAdd1"
  75.     arFormDBFields0(15) = "STAdd1"
  76.     arFormValues0(15) = Request("STAdd1")
  77.     arFormFields0(16) = "TeInst1"
  78.     arFormDBFields0(16) = "TeInst1"
  79.     arFormValues0(16) = Request("TeInst1")
  80.     arFormFields0(17) = "TeSub1"
  81.     arFormDBFields0(17) = "TeSub1"
  82.     arFormValues0(17) = Request("TeSub1")
  83.     arFormFields0(18) = "TeAdd2"
  84.     arFormDBFields0(18) = "TeAdd2"
  85.     arFormValues0(18) = Request("TeAdd2")
  86.     arFormFields0(19) = "TeFrom5"
  87.     arFormDBFields0(19) = "TeFrom5"
  88.     arFormValues0(19) = Request("TeFrom5")
  89.     arFormFields0(20) = "RefPhone4"
  90.     arFormDBFields0(20) = "RefPhone4"
  91.     arFormValues0(20) = Request("RefPhone4")
  92.     arFormFields0(21) = "HomePhone"
  93.     arFormDBFields0(21) = "HomePhone"
  94.     arFormValues0(21) = Request("HomePhone")
  95.     arFormFields0(22) = "Grad1"
  96.     arFormDBFields0(22) = "Grad1"
  97.     arFormValues0(22) = Request("Grad1")
  98.     arFormFields0(23) = "CDate2"
  99.     arFormDBFields0(23) = "CDate2"
  100.     arFormValues0(23) = Request("CDate2")
  101.     arFormFields0(24) = "Degree3"
  102.     arFormDBFields0(24) = "Degree3"
  103.     arFormValues0(24) = Request("Degree3")
  104.     arFormFields0(25) = "CMin4"
  105.     arFormDBFields0(25) = "CMin4"
  106.     arFormValues0(25) = Request("CMin4")
  107.     arFormFields0(26) = "STSub1"
  108.     arFormDBFields0(26) = "STSub1"
  109.     arFormValues0(26) = Request("STSub1")
  110.     arFormFields0(27) = "STAdd2"
  111.     arFormDBFields0(27) = "STAdd2"
  112.     arFormValues0(27) = Request("STAdd2")
  113.     arFormFields0(28) = "TETo1"
  114.     arFormDBFields0(28) = "TETo1"
  115.     arFormValues0(28) = Request("TETo1")
  116.     arFormFields0(29) = "TeInst2"
  117.     arFormDBFields0(29) = "TeInst2"
  118.     arFormValues0(29) = Request("TeInst2")
  119.     arFormFields0(30) = "TeSub2"
  120.     arFormDBFields0(30) = "TeSub2"
  121.     arFormValues0(30) = Request("TeSub2")
  122.     arFormFields0(31) = "TeAdd3"
  123.     arFormDBFields0(31) = "TeAdd3"
  124.     arFormValues0(31) = Request("TeAdd3")
  125.     arFormFields0(32) = "RefPhone5"
  126.     arFormDBFields0(32) = "RefPhone5"
  127.     arFormValues0(32) = Request("RefPhone5")
  128.     arFormFields0(33) = "SocSecNum"
  129.     arFormDBFields0(33) = "SocSecNum"
  130.     arFormValues0(33) = Request("SocSecNum")
  131.     arFormFields0(34) = "HS1"
  132.     arFormDBFields0(34) = "HS1"
  133.     arFormValues0(34) = Request("HS1")
  134.     arFormFields0(35) = "Grad2"
  135.     arFormDBFields0(35) = "Grad2"
  136.     arFormValues0(35) = Request("Grad2")
  137.     arFormFields0(36) = "CDate3"
  138.     arFormDBFields0(36) = "CDate3"
  139.     arFormValues0(36) = Request("CDate3")
  140.     arFormFields0(37) = "Degree4"
  141.     arFormDBFields0(37) = "Degree4"
  142.     arFormValues0(37) = Request("Degree4")
  143.     arFormFields0(38) = "STSub2"
  144.     arFormDBFields0(38) = "STSub2"
  145.     arFormValues0(38) = Request("STSub2")
  146.     arFormFields0(39) = "TETo2"
  147.     arFormDBFields0(39) = "TETo2"
  148.     arFormValues0(39) = Request("TETo2")
  149.     arFormFields0(40) = "TeInst3"
  150.     arFormDBFields0(40) = "TeInst3"
  151.     arFormValues0(40) = Request("TeInst3")
  152.     arFormFields0(41) = "TeSub3"
  153.     arFormDBFields0(41) = "TeSub3"
  154.     arFormValues0(41) = Request("TeSub3")
  155.     arFormFields0(42) = "TeAdd4"
  156.     arFormDBFields0(42) = "TeAdd4"
  157.     arFormValues0(42) = Request("TeAdd4")
  158.     arFormFields0(43) = "OEDate1"
  159.     arFormDBFields0(43) = "OEDate1"
  160.     arFormValues0(43) = Request("OEDate1")
  161.     arFormFields0(44) = "MiddleName"
  162.     arFormDBFields0(44) = "MiddleName"
  163.     arFormValues0(44) = Request("MiddleName")
  164.     arFormFields0(45) = "PAStreet"
  165.     arFormDBFields0(45) = "PAStreet"
  166.     arFormValues0(45) = Request("PAStreet")
  167.     arFormFields0(46) = "JHPosDes"
  168.     arFormDBFields0(46) = "JHPosDes"
  169.     arFormValues0(46) = Request("JHPosDes")
  170.     arFormFields0(47) = "HS2"
  171.     arFormDBFields0(47) = "HS2"
  172.     arFormValues0(47) = Request("HS2")
  173.     arFormFields0(48) = "Grad3"
  174.     arFormDBFields0(48) = "Grad3"
  175.     arFormValues0(48) = Request("Grad3")
  176.     arFormFields0(49) = "CDate4"
  177.     arFormDBFields0(49) = "CDate4"
  178.     arFormValues0(49) = Request("CDate4")
  179.     arFormFields0(50) = "CertSub1"
  180.     arFormDBFields0(50) = "CertSub1"
  181.     arFormValues0(50) = Request("CertSub1")
  182.     arFormFields0(51) = "TETo3"
  183.     arFormDBFields0(51) = "TETo3"
  184.     arFormValues0(51) = Request("TETo3")
  185.     arFormFields0(52) = "TeInst4"
  186.     arFormDBFields0(52) = "TeInst4"
  187.     arFormValues0(52) = Request("TeInst4")
  188.     arFormFields0(53) = "TeSub4"
  189.     arFormDBFields0(53) = "TeSub4"
  190.     arFormValues0(53) = Request("TeSub4")
  191.     arFormFields0(54) = "TeAdd5"
  192.     arFormDBFields0(54) = "TeAdd5"
  193.     arFormValues0(54) = Request("TeAdd5")
  194.     arFormFields0(55) = "OEDate2"
  195.     arFormDBFields0(55) = "OEDate21"
  196.     arFormValues0(55) = Request("OEDate2")
  197.     arFormFields0(56) = "PAState"
  198.     arFormDBFields0(56) = "PAState"
  199.     arFormValues0(56) = Request("PAState")
  200.     arFormFields0(57) = "Grad4"
  201.     arFormDBFields0(57) = "Grad4"
  202.     arFormValues0(57) = Request("Grad4")
  203.     arFormFields0(58) = "CertSub2"
  204.     arFormDBFields0(58) = "CertSub2"
  205.     arFormValues0(58) = Request("CertSub2")
  206.     arFormFields0(59) = "STSchool1"
  207.     arFormDBFields0(59) = "STSchool1"
  208.     arFormValues0(59) = Request("STSchool1")
  209.     arFormFields0(60) = "TETo4"
  210.     arFormDBFields0(60) = "TETo4"
  211.     arFormValues0(60) = Request("TETo4")
  212.     arFormFields0(61) = "TeInst5"
  213.     arFormDBFields0(61) = "TeInst5"
  214.     arFormValues0(61) = Request("TeInst5")
  215.     arFormFields0(62) = "TeSub5"
  216.     arFormDBFields0(62) = "TeSub5"
  217.     arFormValues0(62) = Request("TeSub5")
  218.     arFormFields0(63) = "RefPos1"
  219.     arFormDBFields0(63) = "RefPos1"
  220.     arFormValues0(63) = Request("RefPos1")
  221.     arFormFields0(64) = "STSchool2"
  222.     arFormDBFields0(64) = "STSchool2"
  223.     arFormValues0(64) = Request("STSchool2")
  224.     arFormFields0(65) = "TETo5"
  225.     arFormDBFields0(65) = "TETo5"
  226.     arFormValues0(65) = Request("TETo5")
  227.     arFormFields0(66) = "OEName1"
  228.     arFormDBFields0(66) = "OEName1"
  229.     arFormValues0(66) = Request("OEName1")
  230.     arFormFields0(67) = "OEDate4"
  231.     arFormDBFields0(67) = "OEDate4"
  232.     arFormValues0(67) = Request("OEDate4")
  233.     arFormFields0(68) = "RefPos2"
  234.     arFormDBFields0(68) = "RefPos2"
  235.     arFormValues0(68) = Request("RefPos2")
  236.     arFormFields0(69) = "SHPosDes"
  237.     arFormDBFields0(69) = "SHPosDes"
  238.     arFormValues0(69) = Request("SHPosDes")
  239.     arFormFields0(70) = "OEName2"
  240.     arFormDBFields0(70) = "OEName2"
  241.     arFormValues0(70) = Request("OEName2")
  242.     arFormFields0(71) = "RefAdd1"
  243.     arFormDBFields0(71) = "RefAdd1"
  244.     arFormValues0(71) = Request("RefAdd1")
  245.     arFormFields0(72) = "RefPos3"
  246.     arFormDBFields0(72) = "RefPos3"
  247.     arFormValues0(72) = Request("RefPos3")
  248.     arFormFields0(73) = "Statement"
  249.     arFormDBFields0(73) = "Statement"
  250.     arFormValues0(73) = Request("Statement")
  251.     arFormFields0(74) = "Email"
  252.     arFormDBFields0(74) = "Email"
  253.     arFormValues0(74) = Request("Email")
  254.     arFormFields0(75) = "City"
  255.     arFormDBFields0(75) = "City"
  256.     arFormValues0(75) = Request("City")
  257.     arFormFields0(76) = "College1"
  258.     arFormDBFields0(76) = "College1"
  259.     arFormValues0(76) = Request("College1")
  260.     arFormFields0(77) = "STDate1"
  261.     arFormDBFields0(77) = "STDate1"
  262.     arFormValues0(77) = Request("STDate1")
  263.     arFormFields0(78) = "OEType1"
  264.     arFormDBFields0(78) = "OEType1"
  265.     arFormValues0(78) = Request("OEType1")
  266.     arFormFields0(79) = "OEName3"
  267.     arFormDBFields0(79) = "OEName3"
  268.     arFormValues0(79) = Request("OEName3")
  269.     arFormFields0(80) = "OAList1"
  270.     arFormDBFields0(80) = "OAList1"
  271.     arFormValues0(80) = Request("OAList1")
  272.     arFormFields0(81) = "RefAdd2"
  273.     arFormDBFields0(81) = "RefAdd2"
  274.     arFormValues0(81) = Request("RefAdd2")
  275.     arFormFields0(82) = "RefPos4"
  276.     arFormDBFields0(82) = "RefPos4"
  277.     arFormValues0(82) = Request("RefPos4")
  278.     arFormFields0(83) = "PAZip"
  279.     arFormDBFields0(83) = "PAZip"
  280.     arFormValues0(83) = Request("PAZip")
  281.     arFormFields0(84) = "College2"
  282.     arFormDBFields0(84) = "College2"
  283.     arFormValues0(84) = Request("College2")
  284.     arFormFields0(85) = "NTETA"
  285.     arFormDBFields0(85) = "NTETA"
  286.     arFormValues0(85) = Request("NTETA")
  287.     arFormFields0(86) = "STDate2"
  288.     arFormDBFields0(86) = "STDate2"
  289.     arFormValues0(86) = Request("STDate2")
  290.     arFormFields0(87) = "OEType2"
  291.     arFormDBFields0(87) = "OEType2"
  292.     arFormValues0(87) = Request("OEType2")
  293.     arFormFields0(88) = "OEName4"
  294.     arFormDBFields0(88) = "OEName4"
  295.     arFormValues0(88) = Request("OEName4")
  296.     arFormFields0(89) = "OAList2"
  297.     arFormDBFields0(89) = "OAList2"
  298.     arFormValues0(89) = Request("OAList2")
  299.     arFormFields0(90) = "RefAdd3"
  300.     arFormDBFields0(90) = "RefAdd3"
  301.     arFormValues0(90) = Request("RefAdd3")
  302.     arFormFields0(91) = "RefPos5"
  303.     arFormDBFields0(91) = "RefPos5"
  304.     arFormValues0(91) = Request("RefPos5")
  305.     arFormFields0(92) = "FirstName"
  306.     arFormDBFields0(92) = "FirstName"
  307.     arFormValues0(92) = Request("FirstName")
  308.     arFormFields0(93) = "PACity"
  309.     arFormDBFields0(93) = "PACity"
  310.     arFormValues0(93) = Request("PACity")
  311.     arFormFields0(94) = "College3"
  312.     arFormDBFields0(94) = "College3"
  313.     arFormValues0(94) = Request("College3")
  314.     arFormFields0(95) = "OEType3"
  315.     arFormDBFields0(95) = "OEType3"
  316.     arFormValues0(95) = Request("OEType3")
  317.     arFormFields0(96) = "OAList3"
  318.     arFormDBFields0(96) = "OAList3"
  319.     arFormValues0(96) = Request("OAList3")
  320.     arFormFields0(97) = "RefAdd4"
  321.     arFormDBFields0(97) = "RefAdd4"
  322.     arFormValues0(97) = Request("RefAdd4")
  323.     arFormFields0(98) = "Zip"
  324.     arFormDBFields0(98) = "Zip"
  325.     arFormValues0(98) = Request("Zip")
  326.     arFormFields0(99) = "EPosDes"
  327.     arFormDBFields0(99) = "EPosDes"
  328.     arFormValues0(99) = Request("EPosDes")
  329.     arFormFields0(100) = "College4"
  330.     arFormDBFields0(100) = "College4"
  331.     arFormValues0(100) = Request("College4")
  332.     arFormFields0(101) = "NTE"
  333.     arFormDBFields0(101) = "NTE"
  334.     arFormValues0(101) = Request("NTE")
  335.     arFormFields0(102) = "CertType"
  336.     arFormDBFields0(102) = "CertType"
  337.     arFormValues0(102) = Request("CertType")
  338.     arFormFields0(103) = "OESup1"
  339.     arFormDBFields0(103) = "OESup1"
  340.     arFormValues0(103) = Request("OESup1")
  341.     arFormFields0(104) = "OEType4"
  342.     arFormDBFields0(104) = "OEType4"
  343.     arFormValues0(104) = Request("OEType4")
  344.     arFormFields0(105) = "OAList4"
  345.     arFormDBFields0(105) = "OAList4"
  346.     arFormValues0(105) = Request("OAList4")
  347.     arFormFields0(106) = "RefName1"
  348.     arFormDBFields0(106) = "RefName1"
  349.     arFormValues0(106) = Request("RefName1")
  350.     arFormFields0(107) = "RefAdd5"
  351.     arFormDBFields0(107) = "RefAdd5"
  352.     arFormValues0(107) = Request("RefAdd5")
  353.     arFormFields0(108) = "CMaj1"
  354.     arFormDBFields0(108) = "CMaj1"
  355.     arFormValues0(108) = Request("CMaj1")
  356.     arFormFields0(109) = "CertNum"
  357.     arFormDBFields0(109) = "CertNum"
  358.     arFormValues0(109) = Request("CertNum")
  359.     arFormFields0(110) = "OESup2"
  360.     arFormDBFields0(110) = "OESup2"
  361.     arFormValues0(110) = Request("OESup2")
  362.     arFormFields0(111) = "OAList5"
  363.     arFormDBFields0(111) = "OAList5"
  364.     arFormValues0(111) = Request("OAList5")
  365.     arFormFields0(112) = "RefName2"
  366.     arFormDBFields0(112) = "RefName2"
  367.     arFormValues0(112) = Request("RefName2")
  368.     arFormFields0(113) = "LastName"
  369.     arFormDBFields0(113) = "LastName"
  370.     arFormValues0(113) = Request("LastName")
  371.     arFormFields0(114) = "MSPosDes"
  372.     arFormDBFields0(114) = "MSPosDes"
  373.     arFormValues0(114) = Request("MSPosDes")
  374.     arFormFields0(115) = "CMaj2"
  375.     arFormDBFields0(115) = "CMaj2"
  376.     arFormValues0(115) = Request("CMaj2")
  377.     arFormFields0(116) = "OESup3"
  378.     arFormDBFields0(116) = "OESup3"
  379.     arFormValues0(116) = Request("OESup3")
  380.     arFormFields0(117) = "RefName3"
  381.     arFormDBFields0(117) = "RefName3"
  382.     arFormValues0(117) = Request("RefName3")
  383.     arFormFields0(118) = "AddValid"
  384.     arFormDBFields0(118) = "AddValid"
  385.     arFormValues0(118) = Request("AddValid")
  386.     arFormFields0(119) = "State"
  387.     arFormDBFields0(119) = "State"
  388.     arFormValues0(119) = Request("State")
  389.     arFormFields0(120) = "OtherPosDes"
  390.     arFormDBFields0(120) = "OtherPosDes"
  391.     arFormValues0(120) = Request("OtherPosDes")
  392.     arFormFields0(121) = "DateAvailable"
  393.     arFormDBFields0(121) = "DateAvailable"
  394.     arFormValues0(121) = Request("DateAvailable")
  395.     arFormFields0(122) = "CMaj3"
  396.     arFormDBFields0(122) = "CMaj3"
  397.     arFormValues0(122) = Request("CMaj3")
  398.     arFormFields0(123) = "NTEComm"
  399.     arFormDBFields0(123) = "NTEComm"
  400.     arFormValues0(123) = Request("NTEComm")
  401.     arFormFields0(124) = "TeFrom1"
  402.     arFormDBFields0(124) = "TeFrom1"
  403.     arFormValues0(124) = Request("TeFrom1")
  404.     arFormFields0(125) = "OESup4"
  405.     arFormDBFields0(125) = "OESup4"
  406.     arFormValues0(125) = Request("OESup4")
  407.     arFormFields0(126) = "RefName4"
  408.     arFormDBFields0(126) = "RefName4"
  409.     arFormValues0(126) = Request("RefName4")
  410.     arFormFields0(127) = "WorkPhone"
  411.     arFormDBFields0(127) = "WorkPhone"
  412.     arFormValues0(127) = Request("WorkPhone")
  413.     arFormFields0(128) = "KPosDes"
  414.     arFormDBFields0(128) = "KPosDes"
  415.     arFormValues0(128) = Request("KPosDes")
  416.     arFormFields0(129) = "CMaj4"
  417.     arFormDBFields0(129) = "CMaj4"
  418.     arFormValues0(129) = Request("CMaj4")
  419.     arFormFields0(130) = "TeFrom2"
  420.     arFormDBFields0(130) = "TeFrom2"
  421.     arFormValues0(130) = Request("TeFrom2")
  422.     arFormFields0(131) = "RefPhone1"
  423.     arFormDBFields0(131) = "RefPhone1"
  424.     arFormValues0(131) = Request("RefPhone1")
  425.     arFormFields0(132) = "RefName5"
  426.     arFormDBFields0(132) = "RefName5"
  427.     arFormValues0(132) = Request("RefName5")
  428.  
  429.     FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0
  430.  
  431.     If Request.ServerVariables("REMOTE_HOST") <> "" Then
  432.         FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name"
  433.     End If
  434.     If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then
  435.         FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type"
  436.     End If
  437.     FP_SaveFieldToDB fp_rs, Now, "Timestamp"
  438.     If Request.ServerVariables("REMOTE_USER") <> "" Then
  439.         FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name"
  440.     End If
  441.  
  442.     fp_rs.Update
  443.     FP_DumpError strErrorUrl, "Cannot update the database"
  444.  
  445.     fp_rs.Close
  446.     fp_conn.Close
  447.  
  448.     Session("FP_SavedFields")=arFormFields0
  449.     Session("FP_SavedValues")=arFormValues0
  450.     Response.Redirect "confirmation.asp"
  451.  
  452. End If
  453. End If
  454.  
  455. %>
  456. <html>
  457.  
  458. <head>
  459. <meta http-equiv="Content-Language" content="en-us">
  460. <meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
  461. <meta name="GENERATOR" content="Microsoft FrontPage 5.0">
  462. <meta name="ProgId" content="FrontPage.Editor.Document">
  463. <!--Prototype Certified Application v1.0-->
  464. <!--Keith M. Alman-->
  465. <!--June 20, 2001-->
  466. <title>Certified Application</title>
  467. </head>
  468.  
  469. <body>
  470.  
  471. <table border="0" cellspacing="0" width="100%">
  472.   <tr>
  473.     <td width="100%" align="center"><b>Mountain Home Public Schools</b></td>
  474.   </tr>
  475.   <tr>
  476.     <td width="100%" align="center"><b>2465 Rodeo Drive</b></td>
  477.   </tr>
  478.   <tr>
  479.     <td width="100%" align="center"><b>Mountain Home, Arkansas 72653</b></td>
  480.   </tr>
  481.   <tr>
  482.     <td width="100%" align="center"></td>
  483.   </tr>
  484.   <tr>
  485.     <td width="100%" align="center"><b>Professional Application</b></td>
  486.   </tr>
  487.   <tr>
  488.     <td width="100%" align="center"></td>
  489.   </tr>
  490.   <tr>
  491.     <td width="100%" align="center"><font size="2"><i>This application becomes a part of the
  492.       applicant's official record.</i></font></td>
  493.   </tr>
  494.   <tr>
  495.     <td width="100%" align="center"><font size="2"><i>It must be filled out ACCURATELY AND
  496.       COMPLETELY.</i></font></td>
  497.   </tr>
  498.   <tr>
  499.     <td width="100%"></td>
  500.   </tr>
  501. </table>
  502.  
  503. <form method="POST" action="certified_testing.asp" webbot-action="--WEBBOT-SELF--">
  504.   <!--webbot bot="SaveDatabase" suggestedext="asp" u-asp-include-url="_fpclass/fpdbform.inc" s-dataconnection="certified" s-recordsource="Results" u-database-url="fpdb/certified.mdb" u-confirmation-url="confirmation.asp" u-validation-error-url="error.htm" s-builtin-fields="REMOTE_HOST HTTP_USER_AGENT Timestamp REMOTE_USER" s-builtin-dbfields="Remote_computer_name Browser_type Timestamp User_name" s-form-fields="CMin1 TeFrom3 RefPhone2 Street Degree1 CMin2 NTEComp TeAdd1 TeFrom4 RefPhone3 CDate1 Degree2 CMin3 NTEDate CertEx STAdd1 TeInst1 TeSub1 TeAdd2 TeFrom5 RefPhone4 HomePhone Grad1 CDate2 Degree3 CMin4 STSub1 STAdd2 TETo1 TeInst2 TeSub2 TeAdd3 RefPhone5 SocSecNum HS1 Grad2 CDate3 Degree4 STSub2 TETo2 TeInst3 TeSub3 TeAdd4 OEDate1 MiddleName PAStreet JHPosDes HS2 Grad3 CDate4 CertSub1 TETo3 TeInst4 TeSub4 TeAdd5 OEDate2 PAState Grad4 CertSub2 STSchool1 TETo4 TeInst5 TeSub5 RefPos1 STSchool2 TETo5 OEName1 OEDate4 RefPos2 SHPosDes OEName2 RefAdd1 RefPos3 Statement Email City College1 STDate1 OEType1 OEName3 OAList1 RefAdd2 RefPos4 PAZip College2 NTETA STDate2 OEType2 OEName4 OAList2 RefAdd3 RefPos5 FirstName PACity College3 OEType3 OAList3 RefAdd4 Zip EPosDes College4 NTE CertType OESup1 OEType4 OAList4 RefName1 RefAdd5 CMaj1 CertNum OESup2 OAList5 RefName2 LastName MSPosDes CMaj2 OESup3 RefName3 AddValid State OtherPosDes DateAvailable CMaj3 NTEComm TeFrom1 OESup4 RefName4 WorkPhone KPosDes CMaj4 TeFrom2 RefPhone1 RefName5" s-form-dbfields="CMin1 TeFrom3 RefPhone2 Street Degree1 CMin2 NTEComp TeAdd1 TeFrom4 RefPhone3 CDate1 Degree2 CMin3 NTEDate CertEx STAdd1 TeInst1 TeSub1 TeAdd2 TeFrom5 RefPhone4 HomePhone Grad1 CDate2 Degree3 CMin4 STSub1 STAdd2 TETo1 TeInst2 TeSub2 TeAdd3 RefPhone5 SocSecNum HS1 Grad2 CDate3 Degree4 STSub2 TETo2 TeInst3 TeSub3 TeAdd4 OEDate1 MiddleName PAStreet JHPosDes HS2 Grad3 CDate4 CertSub1 TETo3 TeInst4 TeSub4 TeAdd5 OEDate21 PAState Grad4 CertSub2 STSchool1 TETo4 TeInst5 TeSub5 RefPos1 STSchool2 TETo5 OEName1 OEDate4 RefPos2 SHPosDes OEName2 RefAdd1 RefPos3 Statement Email City College1 STDate1 OEType1 OEName3 OAList1 RefAdd2 RefPos4 PAZip College2 NTETA STDate2 OEType2 OEName4 OAList2 RefAdd3 RefPos5 FirstName PACity College3 OEType3 OAList3 RefAdd4 Zip EPosDes College4 NTE CertType OESup1 OEType4 OAList4 RefName1 RefAdd5 CMaj1 CertNum OESup2 OAList5 RefName2 LastName MSPosDes CMaj2 OESup3 RefName3 AddValid State OtherPosDes DateAvailable CMaj3 NTEComm TeFrom1 OESup4 RefName4 WorkPhone KPosDes CMaj4 TeFrom2 RefPhone1 RefName5" startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--#include file="_fpclass/fpdbform.inc"--><!--webbot bot="SaveDatabase" endspan i-checksum="40548" -->
  505.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  506.     <tr>
  507.       <td width="100%">
  508.         <p align="center"><font size="3"><b>I. PERSONAL</b></font></td>
  509.     </tr>
  510.   </table>
  511.   <table border="0" cellpadding="2" cellspacing="0" width="100%">
  512.     <tr>
  513.       <td width="33%"><font size="2"><b>Last Name:</b></font></td>
  514.       <td width="33%"><font size="2"><b>First Name:</b></font></td>
  515.       <td width="34%"><font size="2"><b>Middle Name:</b></font></td>
  516.     </tr>
  517.     <tr>
  518.       <td width="33%"><font size="2"><b><input type="text" name="LastName" size="20"></b></font></td>
  519.       <td width="33%"><font size="2"><b><input type="text" name="FirstName" size="20"></b></font></td>
  520.       <td width="34%"><font size="2"><b><input type="text" name="MiddleName" size="20"></b></font></td>
  521.     </tr>
  522.     <tr>
  523.       <td width="33%"><font size="2"><b>Email:</b></font></td>
  524.       <td width="33%"><font size="2"><b>Social Security Number</b></font></td>
  525.       <td width="34%" rowspan="2"></td>
  526.     </tr>
  527.     <tr>
  528.       <td width="33%"><font size="2"><b><input type="text" name="Email" size="20"></b></font></td>
  529.       <td width="33%"><font size="2"><b><input type="text" name="SocSecNum" size="20"></b></font></td>
  530.     </tr>
  531.   </table>
  532.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  533.     <tr>
  534.       <td width="100%"><b><font size="2">Present
  535.         Address:          </font></b><font size="1">
  536.         (valid until: </font><b><font size="2"><input type="text" name="AddValid" size="20">)</font></b></td>
  537.     </tr>
  538.   </table>
  539.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  540.     <tr>
  541.       <td width="25%"><font size="2"><b>Street:</b></font></td>
  542.       <td width="25%"><font size="2"><b>City:</b></font></td>
  543.       <td width="25%"><font size="2"><b>State:</b></font></td>
  544.       <td width="25%"><font size="2"><b>Zip:</b></font></td>
  545.     </tr>
  546.     <tr>
  547.       <td width="25%"><input type="text" name="Street" size="20"></td>
  548.       <td width="25%"><input type="text" name="City" size="20"></td>
  549.       <td width="25%"><select size="1" name="State">
  550.           <option value="AL">Alabama</option>
  551.           <option value="AK">Alaska</option>
  552.             <option value="AZ">Arizona</option>
  553.             <option selected value="AR">Arkansas</option>
  554.             <option value="CA">California</option>
  555.             <option value="CO">Colorado</option>
  556.             <option value="CT">Connecticut</option>
  557.             <option value="DE">Delaware</option>
  558.             <option value="DC">District of Columbia</option>
  559.             <option value="FL">Florida</option>
  560.             <option value="GA">Georgia</option>
  561.             <option value="HI">Hawaii</option>
  562.             <option value="ID">Idaho</option>
  563.             <option value="IL">Illinois</option>
  564.             <option value="IN">Indiana</option>
  565.             <option value="IA">Iowa</option>
  566.             <option value="KS">Kansas</option>
  567.             <option value="KY">Kentucky</option>
  568.                <option value="LA">Louisiana</option>
  569.                 <option value="ME">Maine</option>
  570.             <option value="MD">Maryland</option>
  571.             <option value="MA">Massachusetts</option>
  572.             <option value="MI">Michigan</option>
  573.             <option value="MN">Minnesota</option>
  574.             <option value="MS">Mississippi</option>
  575.             <option value="MO">Missouri</option>
  576.             <option value="MT">Montana</option>
  577.             <option value="NE">Nebraska</option>
  578.             <option value="NV">Nevada</option>
  579.             <option value="NH">New Hampshire</option>
  580.             <option value="NJ">New Jersey</option>
  581.             <option value="NM">New Mexico</option>
  582.             <option value="NY">New York</option>
  583.             <option value="NC">North Carolina</option>
  584.             <option value="ND">North Dakota</option>
  585.             <option value="OH">Ohio</option>
  586.             <option value="OK">Oklahoma</option>
  587.             <option value="OR">Oregon</option>
  588.             <option value="PA">Pennsylvania</option>
  589.             <option value="PR">Puerto Rico</option>
  590.             <option value="RI">Rhode Island</option>
  591.             <option value="SC">South Carolina</option>
  592.             <option value="SD">South Dakota</option>
  593.             <option value="TN">Tennessee</option>
  594.             <option value="TX">Texas</option>
  595.             <option value="UT">Utah</option>
  596.             <option value="VT">Vermont</option>
  597.             <option value="VA">Virginia</option>
  598.             <option value="WA">Washington</option>
  599.             <option value="WV">West Virginia</option>
  600.             <option value="WI">Wisconsin</option>
  601.           <option value="WY">Wyoming</option>
  602.         </select></td>
  603.       <td width="25%"><input type="text" name="Zip" size="20"></td>
  604.     </tr>
  605.     <tr>
  606.       <td width="100%" colspan="4"><b><font size="2">Permanent Address </font></b><font size="1">(if
  607.         different Than Present):</font></td>
  608.     </tr>
  609.     <tr>
  610.       <td width="25%"><b><font size="2">Street:</font></b></td>
  611.       <td width="25%"><b><font size="2">City:</font></b></td>
  612.       <td width="25%"><b><font size="2">State:</font></b></td>
  613.       <td width="25%"><b><font size="2">Zip:</font></b></td>
  614.     </tr>
  615.     <tr>
  616.       <td width="25%"><input type="text" name="PAStreet" size="20"></td>
  617.       <td width="25%"><input type="text" name="PACity" size="20"></td>
  618.       <td width="25%"><select size="1" name="PAState">
  619.           <option value="AL">Alabama</option>
  620.           <option value="AK">Alaska</option>
  621.             <option value="AZ">Arizona</option>
  622.             <option selected value="AR">Arkansas</option>
  623.             <option value="CA">California</option>
  624.             <option value="CO">Colorado</option>
  625.             <option value="CT">Connecticut</option>
  626.             <option value="DE">Delaware</option>
  627.             <option value="DC">District of Columbia</option>
  628.             <option value="FL">Florida</option>
  629.             <option value="GA">Georgia</option>
  630.             <option value="HI">Hawaii</option>
  631.             <option value="ID">Idaho</option>
  632.             <option value="IL">Illinois</option>
  633.             <option value="IN">Indiana</option>
  634.             <option value="IA">Iowa</option>
  635.             <option value="KS">Kansas</option>
  636.             <option value="KY">Kentucky</option>
  637.                <option value="LA">Louisiana</option>
  638.                 <option value="ME">Maine</option>
  639.             <option value="MD">Maryland</option>
  640.             <option value="MA">Massachusetts</option>
  641.             <option value="MI">Michigan</option>
  642.             <option value="MN">Minnesota</option>
  643.             <option value="MS">Mississippi</option>
  644.             <option value="MO">Missouri</option>
  645.             <option value="MT">Montana</option>
  646.             <option value="NE">Nebraska</option>
  647.             <option value="NV">Nevada</option>
  648.             <option value="NH">New Hampshire</option>
  649.             <option value="NJ">New Jersey</option>
  650.             <option value="NM">New Mexico</option>
  651.             <option value="NY">New York</option>
  652.             <option value="NC">North Carolina</option>
  653.             <option value="ND">North Dakota</option>
  654.             <option value="OH">Ohio</option>
  655.             <option value="OK">Oklahoma</option>
  656.             <option value="OR">Oregon</option>
  657.             <option value="PA">Pennsylvania</option>
  658.             <option value="PR">Puerto Rico</option>
  659.             <option value="RI">Rhode Island</option>
  660.             <option value="SC">South Carolina</option>
  661.             <option value="SD">South Dakota</option>
  662.             <option value="TN">Tennessee</option>
  663.             <option value="TX">Texas</option>
  664.             <option value="UT">Utah</option>
  665.             <option value="VT">Vermont</option>
  666.             <option value="VA">Virginia</option>
  667.             <option value="WA">Washington</option>
  668.             <option value="WV">West Virginia</option>
  669.             <option value="WI">Wisconsin</option>
  670.           <option value="WY">Wyoming</option>
  671.         </select></td>
  672.       <td width="25%"><input type="text" name="PAZip" size="20"></td>
  673.     </tr>
  674.     <tr>
  675.       <td width="25%"><font size="2"><b>Home Phone:</b></font></td>
  676.       <td width="25%"><font size="2"><b>Work Phone:</b></font></td>
  677.       <td width="50%" rowspan="2" colspan="2"></td>
  678.     </tr>
  679.     <tr>
  680.       <td width="25%"><input type="text" name="HomePhone" size="20"></td>
  681.       <td width="25%"><input type="text" name="WorkPhone" size="20"></td>
  682.     </tr>
  683.   </table>
  684.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  685.     <tr>
  686.       <td width="100%"></td>
  687.     </tr>
  688.     <tr>
  689.       <td width="100%">
  690.         <p align="center"> </p>
  691.         <p align="center"><font size="3"><b>II: POSITION DESIRED</b></font></td>
  692.     </tr>
  693.   </table>
  694.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  695.     <tr>
  696.       <td width="16%"></td>
  697.       <td width="84%"><i><font size="1">list grades and/or subjects in order of
  698.         teaching preference</font></i></td>
  699.     </tr>
  700.     <tr>
  701.       <td width="16%"><font size="2">Kindergarten</font></td>
  702.       <td width="84%"><input type="text" name="KPosDes" size="60"></td>
  703.     </tr>
  704.     <tr>
  705.       <td width="16%"><font size="2">Elementary</font></td>
  706.       <td width="84%"><input type="text" name="EPosDes" size="60"></td>
  707.     </tr>
  708.     <tr>
  709.       <td width="16%"><font size="2">Middle School</font></td>
  710.       <td width="84%"><input type="text" name="MSPosDes" size="60"></td>
  711.     </tr>
  712.     <tr>
  713.       <td width="16%"><font size="2">Junior High</font></td>
  714.       <td width="84%"><input type="text" name="JHPosDes" size="60"></td>
  715.     </tr>
  716.     <tr>
  717.       <td width="16%"><font size="2">Senior High</font></td>
  718.       <td width="84%"><input type="text" name="SHPosDes" size="60"></td>
  719.     </tr>
  720.     <tr>
  721.       <td width="16%"><font size="2">Other position(s)</font></td>
  722.       <td width="84%"><input type="text" name="OtherPosDes" size="60"></td>
  723.     </tr>
  724.     <tr>
  725.       <td width="16%"><font size="2">Date available to begin work</font></td>
  726.       <td width="84%"><input type="text" name="DateAvailable" size="20"></td>
  727.     </tr>
  728.   </table>
  729.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  730.     <tr>
  731.       <td width="100%"></td>
  732.     </tr>
  733.     <tr>
  734.       <td width="100%"> 
  735.         <p align="center"><font size="3"><b>III. EDUCATIONAL BACKGROUND</b></font></td>
  736.     </tr>
  737.   </table>
  738.   <table border="1" cellpadding="0" cellspacing="0" width="100%">
  739.     <tr>
  740.       <td width="39%" colspan="2" align="center"><font size="2">Institutions
  741.         Attended</font></td>
  742.       <td width="16%" align="center"><font size="2">Dates (From-To)</font></td>
  743.       <td width="14%" align="center"><font size="2">Major  Subjects</font></td>
  744.       <td width="15%" align="center"><font size="2">Minor  Subjects</font></td>
  745.       <td width="10%" align="center"><font size="2">Degree</font></td>
  746.       <td width="14%" align="center"><font size="2">Date of Graduation</font></td>
  747.     </tr>
  748.     <tr>
  749.       <td width="12%" rowspan="2"><font size="2">High School</font></td>
  750.       <td width="27%">
  751.         <p align="left"><input type="text" name="HS1" size="25"></td>
  752.       <td width="16%" align="center"><font size="2">n/a</font></td>
  753.       <td width="14%" align="center"><font size="2">n/a</font></td>
  754.       <td width="15%" align="center"><font size="2">n/a</font></td>
  755.       <td width="10%" align="center"><font size="2">n/a</font></td>
  756.       <td width="14%" align="center"><font size="2">n/a</font></td>
  757.     </tr>
  758.     <tr>
  759.       <td width="27%"><input type="text" name="HS2" size="25"></td>
  760.       <td width="16%" align="center"><font size="2">n/a</font></td>
  761.       <td width="14%" align="center"><font size="2">n/a</font></td>
  762.       <td width="15%" align="center"><font size="2">n/a</font></td>
  763.       <td width="10%" align="center"><font size="2">n/a</font></td>
  764.       <td width="14%" align="center"><font size="2">n/a</font></td>
  765.     </tr>
  766.     <tr>
  767.       <td width="12%" rowspan="4"><font size="2">College or University</font></td>
  768.       <td width="27%"><input type="text" name="College1" size="25"></td>
  769.       <td width="16%" align="center"><input type="text" name="CDate1" size="10"></td>
  770.       <td width="14%" align="center"><input type="text" name="CMaj1" size="10"></td>
  771.       <td width="15%" align="center"><input type="text" name="CMin1" size="10"></td>
  772.       <td width="10%" align="center"><input type="text" name="Degree1" size="6"></td>
  773.       <td width="14%" align="center"><input type="text" name="Grad1" size="6"></td>
  774.     </tr>
  775.     <tr>
  776.       <td width="27%"><input type="text" name="College2" size="25"></td>
  777.       <td width="16%" align="center"><input type="text" name="CDate2" size="10"></td>
  778.       <td width="14%" align="center"><input type="text" name="CMaj2" size="10"></td>
  779.       <td width="15%" align="center"><input type="text" name="CMin2" size="10"></td>
  780.       <td width="10%" align="center"><input type="text" name="Degree2" size="6"></td>
  781.       <td width="14%" align="center"><input type="text" name="Grad2" size="6"></td>
  782.     </tr>
  783.     <tr>
  784.       <td width="27%"><input type="text" name="College3" size="25"></td>
  785.       <td width="16%" align="center"><input type="text" name="CDate3" size="10"></td>
  786.       <td width="14%" align="center"><input type="text" name="CMaj3" size="10"></td>
  787.       <td width="15%" align="center"><input type="text" name="CMin3" size="10"></td>
  788.       <td width="10%" align="center"><input type="text" name="Degree3" size="6"></td>
  789.       <td width="14%" align="center"><input type="text" name="Grad3" size="6"></td>
  790.     </tr>
  791.     <tr>
  792.       <td width="27%"><input type="text" name="College4" size="25"></td>
  793.       <td width="16%" align="center"><input type="text" name="CDate4" size="10"></td>
  794.       <td width="14%" align="center"><input type="text" name="CMaj4" size="10"></td>
  795.       <td width="15%" align="center"><input type="text" name="CMin4" size="10"></td>
  796.       <td width="10%" align="center"><input type="text" name="Degree4" size="6"></td>
  797.       <td width="14%" align="center"><input type="text" name="Grad4" size="6"></td>
  798.     </tr>
  799.   </table>
  800.   <table border="0" cellpadding="0" cellspacing="0" width="100%" height="93">
  801.     <tr>
  802.       <td width="100%" colspan="6" height="22"></td>
  803.     </tr>
  804.     <tr>
  805.       <td width="49%" colspan="3" height="22"><font size="2">Have you taken the
  806.         National Teacher's Examination?</font></td>
  807.       <td width="17%" height="22"><select size="1" name="NTE">
  808.           <option selected>-</option>
  809.           <option value="Yes">Yes</option>
  810.           <option value="No">No</option>
  811.         </select></td>
  812.       <td width="17%" height="22">
  813.         <p align="right"><font size="2">Date:</font></td>
  814.       <td width="17%" height="22"><input type="text" name="NTEDate" size="10"></td>
  815.     </tr>
  816.     <tr>
  817.       <td width="100%" colspan="6" height="19"><font size="2">NTE Scores (If
  818.         applicable):</font></td>
  819.     </tr>
  820.     <tr>
  821.       <td width="16%" height="22"><font size="2">Commons:</font></td>
  822.       <td width="16%" height="22"><input type="text" name="NTEComm" size="10"></td>
  823.       <td width="17%" height="22"><font size="2">Teaching Area</font></td>
  824.       <td width="17%" height="22"><input type="text" name="NTETA" size="10"></td>
  825.       <td width="17%" height="22"><font size="2">Composite</font></td>
  826.       <td width="17%" height="22"><input type="text" name="NTEComp" size="10"></td>
  827.     </tr>
  828.   </table>
  829.   <hr>
  830.   <table border="1" cellpadding="0" cellspacing="0" width="100%">
  831.     <tr>
  832.       <td width="100%"><font size="2">A college transcript and two letters of
  833.         professional references are required before this application can be
  834.         considered.  A partial transcript will be accepted for candidates
  835.         still working on degrees.  Transcripts will not be returned.</font></td>
  836.     </tr>
  837.   </table>
  838.   <hr>
  839.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  840.     <tr>
  841.       <td width="100%"> 
  842.         <p align="center">IV. PROFESSIONAL EXPERIENCE</td>
  843.     </tr>
  844.   </table>
  845.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  846.     <tr>
  847.       <td width="25%">
  848.         <p align="right"><font size="2">Do you hold an Arkansas teaching
  849.         certificate?</font></td>
  850.       <td width="15%">  <select size="1" name="NTE">
  851.           <option selected>  -</option>
  852.           <option value="Yes">Yes</option>
  853.           <option value="No">No</option>
  854.         </select></td>
  855.       <td width="25%">
  856.         <p align="right"><font size="2">What is your preferred subject to teach?</font></td>
  857.       <td width="35%">   <input type="text" name="CertSub2" size="20"></td>
  858.     </tr>
  859.     <tr>
  860.       <td width="40%" colspan="2">
  861.         <p align="right"><font size="2">If no, please explain:</font></td>
  862.       <td width="60%" colspan="2">
  863.         <p align="left"><input type="text" name="CertEx" size="40"></td>
  864.     </tr>
  865.     <tr>
  866.       <td width="100%" colspan="4">
  867.         <p align="center"><font size="2">If yes, please send a copy of your
  868.         certificate to Mountain Home Public Schools.</font></td>
  869.     </tr>
  870.     <tr>
  871.       <td width="25%">
  872.         <p align="right"><font size="2">Certificate Number:  </font></td>
  873.       <td width="15%"><input type="text" name="CertNum" size="10"></td>
  874.       <td width="25%">
  875.         <p align="right"><font size="2">Type of Certificate:   </font></td>
  876.       <td width="35%"><input type="text" name="CertType" size="25"></td>
  877.     </tr>
  878.     <tr>
  879.       <td width="25%">
  880.         <p align="right"><font size="2">List subjects certified to
  881.         teach:   </font></td>
  882.       <td width="75%" colspan="3">  <input type="text" name="CertSub1" size="50"></td>
  883.     </tr>
  884.   </table>
  885.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  886.     <tr>
  887.       <td width="100%" colspan="4"></td>
  888.     </tr>
  889.     <tr>
  890.       <td width="100%" colspan="4" align="center"><font size="2">Student
  891.         Teaching Experience</font></td>
  892.     </tr>
  893.     <tr>
  894.       <td width="25%" align="center"><font size="2">School</font></td>
  895.       <td width="25%" align="center"><font size="2">Address</font></td>
  896.       <td width="25%" align="center"><font size="2">Subject/Grade</font></td>
  897.       <td width="25%" align="center"><font size="2">Inclusive Dates</font></td>
  898.     </tr>
  899.     <tr>
  900.       <td width="25%" align="center"><input type="text" name="STSchool1" size="20"></td>
  901.       <td width="25%" align="center"><input type="text" name="STAdd1" size="20"></td>
  902.       <td width="25%" align="center"><input type="text" name="STSub1" size="20"></td>
  903.       <td width="25%" align="center"><input type="text" name="STDate1" size="20"></td>
  904.     </tr>
  905.     <tr>
  906.       <td width="25%" align="center"><input type="text" name="STSchool2" size="20"></td>
  907.       <td width="25%" align="center"><input type="text" name="STAdd2" size="20"></td>
  908.       <td width="25%" align="center"><input type="text" name="STSub2" size="20"></td>
  909.       <td width="25%" align="center"><input type="text" name="STDate2" size="20"></td>
  910.     </tr>
  911.   </table>
  912.   <table border="1" cellpadding="0" cellspacing="0" width="100%">
  913.     <tr>
  914.       <td width="100%" colspan="5">
  915.         <p align="center"> </p>
  916.         <p align="center"><font size="2">Teaching Experience</font></td>
  917.     </tr>
  918.     <tr>
  919.       <td width="20%" align="center"><font size="2">Name of Institution</font></td>
  920.       <td width="27%" align="center"><font size="2">Address</font></td>
  921.       <td width="25%" align="center"><font size="2">Subject/Grade</font></td>
  922.       <td width="16%" align="center"><font size="2">Employed from Mo/Yr</font></td>
  923.       <td width="12%" align="center"><font size="2">Employed to Mo/Yr</font></td>
  924.     </tr>
  925.     <tr>
  926.       <td width="20%" align="center"><input type="text" name="TeInst1" size="20"></td>
  927.       <td width="27%" align="center"><input type="text" name="TeAdd1" size="20"></td>
  928.       <td width="25%" align="center"><input type="text" name="TeSub1" size="15"></td>
  929.       <td width="16%" align="center"><input type="text" name="TeFrom1" size="10"></td>
  930.       <td width="12%" align="center"><input type="text" name="TETo1" size="10"></td>
  931.     </tr>
  932.     <tr>
  933.       <td width="20%" align="center"><input type="text" name="TeInst2" size="20"></td>
  934.       <td width="27%" align="center"><input type="text" name="TeAdd2" size="20"></td>
  935.       <td width="25%" align="center"><input type="text" name="TeSub2" size="15"></td>
  936.       <td width="16%" align="center"><input type="text" name="TeFrom2" size="10"></td>
  937.       <td width="12%" align="center"><input type="text" name="TETo2" size="10"></td>
  938.     </tr>
  939.     <tr>
  940.       <td width="20%" align="center"><input type="text" name="TeInst3" size="20"></td>
  941.       <td width="27%" align="center"><input type="text" name="TeAdd3" size="20"></td>
  942.       <td width="25%" align="center"><input type="text" name="TeSub3" size="15"></td>
  943.       <td width="16%" align="center"><input type="text" name="TeFrom3" size="10"></td>
  944.       <td width="12%" align="center"><input type="text" name="TETo3" size="10"></td>
  945.     </tr>
  946.     <tr>
  947.       <td width="20%" align="center"><input type="text" name="TeInst4" size="20"></td>
  948.       <td width="27%" align="center"><input type="text" name="TeAdd4" size="20"></td>
  949.       <td width="25%" align="center"><input type="text" name="TeSub4" size="15"></td>
  950.       <td width="16%" align="center"><input type="text" name="TeFrom4" size="10"></td>
  951.       <td width="12%" align="center"><input type="text" name="TETo4" size="10"></td>
  952.     </tr>
  953.     <tr>
  954.       <td width="20%" align="center"><input type="text" name="TeInst5" size="20"></td>
  955.       <td width="27%" align="center"><input type="text" name="TeAdd5" size="20"></td>
  956.       <td width="25%" align="center"><input type="text" name="TeSub5" size="15"></td>
  957.       <td width="16%" align="center"><input type="text" name="TeFrom5" size="10"></td>
  958.       <td width="12%" align="center"><input type="text" name="TETo5" size="10"></td>
  959.     </tr>
  960.   </table>
  961.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  962.     <tr>
  963.       <td width="100%"></td>
  964.     </tr>
  965.     <tr>
  966.       <td width="100%">
  967.         <p align="center"> </p>
  968.         <p align="center"><font size="2">Experience other than teaching (from
  969.         most recent)</font></td>
  970.     </tr>
  971.   </table>
  972.   <table border="1" cellpadding="0" cellspacing="0" width="100%">
  973.     <tr>
  974.       <td width="36%" align="center"><font size="2">Name and Address of Employer</font></td>
  975.       <td width="23%" align="center"><font size="2">Supervisor's Name</font></td>
  976.       <td width="20%" align="center"><font size="2">Inclusive Dates</font></td>
  977.       <td width="21%" align="center"><font size="2">Type of work</font></td>
  978.     </tr>
  979.     <tr>
  980.       <td width="36%" align="center"><input type="text" name="OEName1" size="30"></td>
  981.       <td width="23%" align="center"><input type="text" name="OESup1" size="20"></td>
  982.       <td width="20%" align="center"><input type="text" name="OEDate1" size="15"></td>
  983.       <td width="21%" align="center"><input type="text" name="OEType1" size="15"></td>
  984.     </tr>
  985.     <tr>
  986.       <td width="36%" align="center"><input type="text" name="OEName2" size="30"></td>
  987.       <td width="23%" align="center"><input type="text" name="OESup2" size="20"></td>
  988.       <td width="20%" align="center"><input type="text" name="OEDate2" size="15"></td>
  989.       <td width="21%" align="center"><input type="text" name="OEType2" size="15"></td>
  990.     </tr>
  991.     <tr>
  992.       <td width="36%" align="center"><input type="text" name="OEName3" size="30"></td>
  993.       <td width="23%" align="center"><input type="text" name="OESup3" size="20"></td>
  994.       <td width="20%" align="center"><input type="text" name="OEDate21" size="15"></td>
  995.       <td width="21%" align="center"><input type="text" name="OEType3" size="15"></td>
  996.     </tr>
  997.     <tr>
  998.       <td width="36%" align="center"><input type="text" name="OEName4" size="30"></td>
  999.       <td width="23%" align="center"><input type="text" name="OESup4" size="20"></td>
  1000.       <td width="20%" align="center"><input type="text" name="OEDate4" size="15"></td>
  1001.       <td width="21%" align="center"><input type="text" name="OEType4" size="15"></td>
  1002.     </tr>
  1003.   </table>
  1004.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  1005.     <tr>
  1006.       <td width="100%"></td>
  1007.     </tr>
  1008.     <tr>
  1009.       <td width="100%"> 
  1010.         <p> </td>
  1011.     </tr>
  1012.   </table>
  1013.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  1014.     <tr>
  1015.       <td width="100%">
  1016.         <p align="center"><font size="2">Other Activities: <i>List hobbies,
  1017.         professional recognition, articles for publication, and committee
  1018.         activities; civil, professional or social organizations, etc.</i></font></td>
  1019.     </tr>
  1020.     <tr>
  1021.       <td width="100%"><input type="text" name="OAList1" size="80"></td>
  1022.     </tr>
  1023.     <tr>
  1024.       <td width="100%"><input type="text" name="OAList2" size="80"></td>
  1025.     </tr>
  1026.     <tr>
  1027.       <td width="100%"><input type="text" name="OAList3" size="80"></td>
  1028.     </tr>
  1029.     <tr>
  1030.       <td width="100%"><input type="text" name="OAList4" size="80"></td>
  1031.     </tr>
  1032.     <tr>
  1033.       <td width="100%"><input type="text" name="OAList5" size="80"></td>
  1034.     </tr>
  1035.   </table>
  1036.   <p> </p>
  1037.   <table border="1" cellpadding="0" cellspacing="0" width="100%">
  1038.     <tr>
  1039.       <td width="100%" colspan="4" align="center"><font size="2"><b>References</b></font></td>
  1040.     </tr>
  1041.     <tr>
  1042.       <td width="100%" colspan="4" align="center"><font size="2">(Give at least
  1043.         five references, including superintendents and principals under whom you
  1044.         have taught, who have first-hand knowledge of your character,
  1045.         personality, scholarship and teaching ability.)</font></td>
  1046.     </tr>
  1047.     <tr>
  1048.       <td width="100%" colspan="4" align="center" height="5"></td>
  1049.     </tr>
  1050.     <tr>
  1051.       <td width="25%" align="center">
  1052.         <p align="center"><font size="2">Name</font></td>
  1053.       <td width="25%" align="center"><font size="2">Address</font></td>
  1054.       <td width="25%" align="center"><font size="2">Official Position</font></td>
  1055.       <td width="25%" align="center"><font size="2">Phone</font></td>
  1056.     </tr>
  1057.     <tr>
  1058.       <td width="25%" align="center"><input type="text" name="RefName1" size="25"></td>
  1059.       <td width="25%" align="center"><input type="text" name="RefAdd1" size="20"></td>
  1060.       <td width="25%" align="center"><input type="text" name="RefPos1" size="20"></td>
  1061.       <td width="25%" align="center"><input type="text" name="RefPhone1" size="15"></td>
  1062.     </tr>
  1063.     <tr>
  1064.       <td width="25%" align="center"><input type="text" name="RefName2" size="25"></td>
  1065.       <td width="25%" align="center"><input type="text" name="RefAdd2" size="20"></td>
  1066.       <td width="25%" align="center"><input type="text" name="RefPos2" size="20"></td>
  1067.       <td width="25%" align="center"><input type="text" name="RefPhone2" size="15"></td>
  1068.     </tr>
  1069.     <tr>
  1070.       <td width="25%" align="center"><input type="text" name="RefName3" size="25"></td>
  1071.       <td width="25%" align="center"><input type="text" name="RefAdd3" size="20"></td>
  1072.       <td width="25%" align="center"><input type="text" name="RefPos3" size="20"></td>
  1073.       <td width="25%" align="center"><input type="text" name="RefPhone3" size="15"></td>
  1074.     </tr>
  1075.     <tr>
  1076.       <td width="25%" align="center"><input type="text" name="RefName4" size="25"></td>
  1077.       <td width="25%" align="center"><input type="text" name="RefAdd4" size="20"></td>
  1078.       <td width="25%" align="center"><input type="text" name="RefPos4" size="20"></td>
  1079.       <td width="25%" align="center"><input type="text" name="RefPhone4" size="15"></td>
  1080.     </tr>
  1081.     <tr>
  1082.       <td width="25%" align="center"><input type="text" name="RefName5" size="25"></td>
  1083.       <td width="25%" align="center"><input type="text" name="RefAdd5" size="20"></td>
  1084.       <td width="25%" align="center"><input type="text" name="RefPos5" size="20"></td>
  1085.       <td width="25%" align="center"><input type="text" name="RefPhone5" size="15"></td>
  1086.     </tr>
  1087.   </table>
  1088.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  1089.     <tr>
  1090.       <td width="100%"></td>
  1091.     </tr>
  1092.     <tr>
  1093.       <td width="100%"></td>
  1094.     </tr>
  1095.     <tr>
  1096.       <td width="100%">
  1097.         <p align="center"><font size="2">Please write a brief statement which
  1098.         would include your reasons for choosing teaching as a profession and
  1099.         your basic philosophy of education in relation to your particular field.</font></td>
  1100.     </tr>
  1101.     <tr>
  1102.       <td width="100%">
  1103.         <p align="center"><font size="2"><textarea rows="10" name="Statement" cols="56"></textarea></font></td>
  1104.     </tr>
  1105.   </table>
  1106.   <p> </p>
  1107.   <table border="1" cellpadding="0" cellspacing="0" width="100%">
  1108.     <tr>
  1109.       <td width="100%">By clicking the "submit" button below I hereby
  1110.         certify that the knowledge furnished on this application form is true
  1111.         and accurate to the best of my knowledge</td>
  1112.     </tr>
  1113.   </table>
  1114.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  1115.     <tr>
  1116.       <td width="100%"></td>
  1117.     </tr>
  1118.     <tr>
  1119.       <td width="100%">
  1120.         <p align="center"><font size="2">Equal Opportunity Employer</font></p>
  1121.         <p><font size="2">The Mountain Home School District does not
  1122.         discriminate on the basis of race, color, national origin, gender,
  1123.         religion, political affiliation, age or disability in employment or the
  1124.         provision of services.</font></td>
  1125.     </tr>
  1126.     <tr>
  1127.       <td width="100%"></td>
  1128.     </tr>
  1129.   </table>
  1130.   <table border="0" cellpadding="0" cellspacing="0" width="100%">
  1131.     <tr>
  1132.       <td width="20%"></td>
  1133.       <td width="20%">
  1134.         <p align="center"><font size="2"><b><input type="submit" value="Submit" name="B1"></b></font></td>
  1135.       <td width="20%"></td>
  1136.       <td width="20%">
  1137.         <p align="center"><font size="2"><b><input type="reset" value="Reset" name="B2"></b></font></td>
  1138.       <td width="20%"></td>
  1139.     </tr>
  1140.   </table>
  1141. </form>
  1142.  
  1143. </body>
  1144.  
  1145. </html>