THE GOVERNOR’S SCHOOL OF NORTH CAROLINA
EMPLOYMENT APPLICATION – 2016 SESSION
COMPLETE THIS APPLICATION ELECTRONICALLY – ONLY HANDWRITE YOUR SIGNATURE
This is a common application used by all Governor’s School employment applicants. Questions on pages 3 are position-specific and
require attached answers. Openings are posted on the Governor’s School website (www.ncgovschool.org) and are updated until all
positions are filled. The North Carolina Department of Public Instruction (DPI) will contact applicants by email upon receipt of their
applications. Final selection processes include a live or recorded interview with DPI and the directors of Governor’s School East and
West. The employment period is mid-June through late July.
PERSONAL INFORMATION AND INTENT
Name
/
/
Last Four Digits of Social Security #
Current Mailing Address
City
County of Residence
Home #
DATE
-
-
State
Zip
E-Mail Address
Work #
-
-
Cellular #
-
-
Fax #
-
-
Governor’s School Positions: Instructors and Support Staff
See the Governor’s School website for vacancies. Instructor positions include specific Area I disciplines (academics and arts
subjects) and Area II. See page 5 for course descriptions. Support Staff positions, including Teaching Assistant/Counselor
(TAC) roles, include specific academic/arts or administrative roles.
Position Desired
1st Choice:
2nd Choice:
(Use the specific position from the Governor’s School website. Instructors: indicate if you have a specialty within
your discipline; e.g., Instrumental Music/Strings, Natural Science/Physics. Support staff: list the specific role. TACs:
list preference for the assistant part of your role; e.g., TAC/English, TAC/Office.)
Which site do you prefer?
Governor’s School West (Winston-Salem)
Governor’s School East (Raleigh)
If a position is available, are you willing/able to accept employment at either site?
Yes
No
Equal Opportunity Information
The North Carolina Governor’s School is an equal opportunity employer within the Department of Public Instruction. State
Government policy prohibits discrimination based on race, sex, color, creed, national origin, age or disability. Sex, age or absence of
disability is a bona fide occupational qualification in a small number of State jobs. The information requested below will in no way
affect you as an applicant. Its sole use will be to see how well our recruitment efforts are reaching all segments of the population.
ETHNIC GROUP
White (non-Hispanic)
Black (non-Hispanic)
Asian (including Pacific Islander)
American Indian (including Alaskan native)
Hispanic (Mexican, Puerto Rican, Cuban, Central or South American, other Spanish origin regardless of race)
Date of Birth
/
/
Gender
Male
Female
DISABILITY: “Disability means, with respect to an individual: (1) a physical or mental impairment that substantially
limits one or more of the major life activities of such individual; (2) a record of such an impairment; or (3) being
regarded as having such an impairment” (Americans with Disabilities Act of 1990). Persons without a disability should
check item A. The reporting of a disability is strictly VOLUNTARY. Persons with disabilities who DO NOT WISH to
report their disabilities should check item A. Information reported on this form will be kept confidential as required by
State law. Public disclosure of this information without your con sent would be a violation of G.S. 126-27.
A
None/Prefer not to report
G Respiratory impairment
B
Blind or severely visually impaired
H
Nervous system/Neurological disorder
C
Deaf or severely hearing impaired
I
Mentally restored
D
Loss or limited use of arms and/or hands
J
Mental retardation
E
Non-ambulatory (must use wheelchair)
K
Learning disability
F
Other orthopedic impairment (including
L
Others (heart disease, diabetes, speech
amputation, arthritis, back injury, cerebral palsy,
impairment)
spina bifida, etc.)
M
Other (please specify)
Availability Do you now work for the State of NC?
Yes
No
Are you related by blood or marriage to any person now working for the State? If yes, give name, relationship to you
and the agency where employed.
Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not
mean you cannot be hired. The offense and how recently you were convicted will be evaluated in relation to the job for
which you are applying.)
YES
NO (If yes, explain fully on an additional sheet.)
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EDUCATIONAL TRAINING (Begin with most recent experience.)
Institution
City, State
Dates
Diploma or Degree Program
Completed?
YES
NO
YES
NO
YES
NO
YES
NO
PROFESSIONAL TEACHING EXPERIENCE (Begin with most recent; other work experience on page 3.)
Current or Last School or School
System:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Supervisor’s Name & Telephone
Number:
Part Time
Years
Months
School or School System:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Supervisor’s Name & Telephone
Number:
Part Time
Years
Months
School or School System:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Supervisor’s Name & Telephone
Number:
Part Time
Years
Months
School or School System:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Part Time
Years
Months
Supervisor’s Name & Telephone
Number:
Job Title, including grade or subjects:
No. Supervised by
you:
Reason for Leaving:
If part time, number
of hours worked per
week:
May We Contact Employer?
YES
NO
Job Title, including grade or subjects:
No. Supervised by
you:
If part time, number
of hours worked per
week:
Job Title, including grade or subjects:
No. Supervised by
you:
If yes, when?
Which campus?
Worked at the NC Governor’s School?
If yes, when?
Which campus?
Reason for Leaving:
If part time, number
of hours worked per
week:
Job Title, including grade or subjects:
No. Supervised by
you:
If part time, number
of hours worked per
week:
NORTH CAROLINA GOVERNOR’S SCHOOL EXPERIENCE
Attended the NC Governor’s School?
Reason for Leaving:
YES
NO
What Area?
YES
NO
What Area(s)?
2
Reason for Leaving:
WORK EXPERIENCE List any full-time work experience outside the teaching profession within the past ten
years. Begin with the most recent experience. (All applicants)
Current or Last Employer:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Supervisor’s Name & Telephone
Number:
Part Time
Years
Months
Employer:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Supervisor’s Name & Telephone
Number:
Part Time
Years
Months
Employer:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Supervisor’s Name & Telephone
Number:
Part Time
Years
Months
Employer:
City, State:
Date Employed/Date Separated:
Full Time
Years
Months
Part Time
Years
Months
Supervisor’s Name & Telephone
Number:
Job Title:
No. Supervised by you:
Reason for Leaving:
If part time, number of
hours worked per week:
May We Contact Employer?
YES
NO
Job Title:
No. Supervised by you:
Reason for Leaving:
If part time, number of
hours worked per week:
Job Title:
No. Supervised by you:
Reason for Leaving:
If part time, number of
hours worked per week:
Job Title:
No. Supervised by you:
Reason for Leaving:
If part time, number of
hours worked per week:
What professional certificates/licensures do you hold?
In what professional organizations, clubs or societies do you hold memberships?
List the professional activities in which you have recently participated.
Are you a certified Emergency Medical Responder?
YES
NO
Certified Lifeguard?
YES
NO
ADDITIONAL QUESTIONS
On one or more attached page(s), answer all the following questions according to your applying position.
ALL APPLICANTS

Why do you seek employment at the Governor’s School?
INSTRUCTOR APPLICANTS ONLY
1. The Governor’s School’s unique curriculum is briefly described on page 5. What prior teaching experiences
prepare you to teach the subject for which you are applying?
2. The emphasis at the Governor’s School is on contemporary ideas in all fields. What experiences in your
discipline prepare you for such an emphasis?
SUPPORT STAFF APPLICANTS ONLY, INCLUDING TACs (EVEN IF THIS IS YOUR SECOND CHOICE)
1. Explain a particular experience, talent or interest that prepares you for the position you seek.
2. If you are primarily interested in an academic/arts position, name a particular and new concept, text, artistic
piece, etc., you believe you know well and would like to contribute to this area.
3. If you are primarily interested in an administrative position, name a particular technological resource or
administrative skill you believe you possess/know well and can contribute to the position.
4. If we do not have a position in the area for which you are applying, would you be willing to undertake other
tasks? If so, suggest what you would be interested in and qualified to do.
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REFERENCES
List three persons who have firsthand knowledge of your training, teaching ability, experience or other qualifications for
the position(s) you seek. Names of persons acquainted with you professionally are preferred.
Name and Position
Mailing/Email Address
Telephone
–
–
–
–
–
–
If you wish, attach a current resume or curriculum vitae. If you have a current university/college transcript,
please attach it to this application form also.
I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the
event confirmation is needed in connection with my work, I authorize educational institutions, associations,
registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I
authorize investigation of all statements made in this application and understand that false information or
documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary
action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon employment
shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S. 126-30, G.S.
14-122.1.)
_____________________________________________________
Signature of Applicant (unsigned applications will not be processed)
Application Submission – Include All Attachments
Mail to:
Governor’s School of North Carolina
Exceptional Children Division
NC Department of Public Instruction
6356 Mail Service Center
Raleigh, NC 27699-6356
or Scan/Email to:
ncgovschool@dpi.nc.gov
Revised January 2016
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Governor’s School Curriculum
The curriculum of the Governor’s School of North Carolina consists of three parts: Area I, Area II, and Area III. Area I is the academic or
performing/visual arts subject in which the student is nominated. Areas II and III are courses that seek to integrate the ideas generated
in Area I classes. Area II’s emphasis is on philosophical connections, Area III’s on personal ones. Area I classes meet twice a day,
Monday through Friday, and once on Saturday. Area II and Area III classes meet three times a week each.
AREA I
Study in each Area I discipline emphasizes theory over the memorization of fact, particularly contemporary and progressive theories that
stimulate innovative thought in a rapidly changing culture. Courses and activities are designed to stimulate student creativity, move
students to question basic assumptions, explore unanswered questions, and develop an acceptance of the process of change.
Art
In the visual arts curriculum, students study and practice visual expression consistent with current concepts and styles. Emphasis is
placed on creative expression as students investigate and examine movement and theories in contemporary art.
Choral Music
The choral music curriculum includes choral works ranging from traditional to modern to experimental. By concentrating on music of 20th
and 21st century composers, students learn the finer points of choral singing – blend, diction, tone quality – and vocal techniques in
rehearsals and performance. The aim is to take students from music that is relatively familiar in form and content to repertoire that is quite
challenging aesthetically, intellectually, and technically.
Dance
The dance curriculum embraces and expresses 20 th and 21st century theories through daily modern technique classes, a survey of recent
historical pioneers, and the integration of self-expression and abstraction through improvision, composition, and choreography.
Theater
The goal of the theater curriculum is to introduce young theater artists to contemporary and progressive theory, literature and technique.
The approach is holistic, encouraging the actor to become a well-rounded, life-long student of the theater.
English
The English curriculum focuses on modern and postmodern fiction, poetry, and drama. The students are encouraged to read closely,
imaginatively, analytically, and empathetically. Some teachers present prewriting and revising strategies to help students improve
their writing.
Foreign Language: French (East)
French students improve their skills in reading, writing and conversing and examine the emerging literature, music and art of French
cultures. The class is presented in French to encourage students to improve skills in reading, writing, and oral communications.
Foreign Language: Spanish (West)
The goal of Spanish is to expose the student to contemporary thought, literature, music, art, and political trends coming from Spain
and Hispanic America. The class is presented in Spanish to encourage students to improve skills in reading, writing, and oral
communications.
Instrumental Music
The focus of instrumental music is the study and performance of significant 20 th and 21st century repertoire for orchestra (West) or wind
ensemble (East), small ensembles, and the creation and performance of student works. The aim is to take students from music that is
relatively familiar in form and content to repertoire that is quite challenging aesthetically, intellectually, and technically.
Mathematics
The mathematics program strives to provide an atmosphere for students to independently contemplate and investigate problems that
arise in contemporary mathematical fields. In addition, the program provides many opportunities, through student-faculty interaction,
seminars and invited lecturers, for students to gain an appreciation for both mathematics and the work of mathematicians.
Natural Science
The natural science curriculum investigates contemporary theories and topics of modern science by the use of interactive seminar,
discussion, group and individual problem solving.
Social Science
The social science curriculum examines the major political, sociological, psychological and anthropological concepts which have
influenced the 20th and 21st centuries from theoretical and applied perspectives.
AREA II
Each student attends another class comprised of students from each of the Area I disciplines. Here students and teachers explore
connections between and among these disciplines. As integrative concepts emerge, the class attempts to construct an understanding of
contemporary ways of thinking and of the culture that arises from them.
AREA III
This third class is also comprised of students from each of the Area I disciplines. Here students attempt to ground what they are learning
in their Area I and II classes in their own personal experience. Finally, they apply that understanding to their social worlds.
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