BOARD OF EDUCATION OF THE CITY OF NEW YORK
                                                    OFFICE OF SCHOOL FOOD AND NUTRITION SERVICES
                                                                         44-36 VERNON BOULEVARD
                                                                 LONG ISLAND CITY, NEW YORK  11101

(718) 729-6100

HIGH  SCHOOL  TEACHER  APPLICATION

2001 SUMMER BREAKFAST/LUNCH PROGRAM

(PLEASE   PRINT   CLEARLY)

Social Security #: ________     ________    _________

Mr.  /Mrs.  / Ms._________________________________________________________________                  
                                   First Name                               Last Name                                        Middle Initial

  Home Address:__________________________________________________________________                                       Number/Street                             City/State                            Zip

Home Telephone:   (        )    __________  -  ___________________

2000-2001
Day School Assignment __________ ___________________ ___________________
  District School Borough

File Number ______________________    2000 – 2001   Working License: _______________________

Do you claim Retention Rights in this activity?  YES (     )    NO (     )

(NOTE:  Retention Rights may be claimed after serving two satisfactory consecutive years in the activity).

Did you work in the Summer Breakfast/Lunch Program in 2000?  YES (    )    NO (     )

If YES, in what School did you work? ___________      ________________________________________                                                           District                                          School

Under what Type of License are you serving? _______________________________________

1.              In how many Per Session Programs have you served since July 1, 2000? ( a Per Session activity
       of 25 hours or less and certain other activities are not counted when  determining the number of  Per Session activities served in) ______________________

2.             How many Per Session Hours do you expect to work from July 1, 2000 to and including
    June 30, 2001?  ______________

3.         Have you claimed Retention Rights in any Per Session position?   YES (     )     NO (     )

If YES, which one? _____________________________________________  

 
Teachers currently on sabbaticals or planning to take sabbaticals should consult Chancellor’s  Regulations
C-175 to ensure compliance with per session employment.  
I, HEREBY, CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE
STATEMENTS IN THE FOREGOING APPLICATIONS ARE TRUE, COMPLETE AND
ACCURATE AND ANY MISREPRESENTATION OF MATERIAL FACTS ON THIS
APPLICATION THROUGH MISSTATEMENTS OR OMISSIONS MAY CAUSE
INVALIDATION OF THIS APPLICATION.  

N.B.  Please note that service exceeding 400 hours, OR more than one (1) Per Session Activity
requires the prior specific written approval of the Executive Director of Personnel.  Each applicant
must attach approved waiver (O.P. 175W) in addition to OP 175 – to this application if he/she works
more than 400  hours OR holds more than one Per – Session Activity.  Applications lacking this required
documentation cannot be processed!

 

DDF/sy
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1/04/01