Career Technical Education Teaching Credential … Holders Application.pdfmultiple subject, single subject and education specialist credential holders Thank you for your interest in

Revised: 8/1/16

Career Technical Education Teaching Credential Program

PART I

CREDENTIAL AND PROGRAM

REQUIREMENTS FOR MULTIPLE SUBJECT, SINGLE SUBJECT, and EDUCATION SPECIALIST

CREDENTIAL HOLDERS

Orange County Department of Education Instructional Services

Institute for Leadership Development

Revised: 8/1/16

TO CAREER TECHNICAL EDUCATION (CTE) TEACHER CREDENTIAL CANDIDATES: MULTIPLE SUBJECT, SINGLE SUBJECT and EDUCATION SPECIALIST CREDENTIAL HOLDERS Thank you for your interest in becoming a new Career Technical Education (CTE) teacher. The Orange County Department of Education (OCDE) is an approved Commission on Teacher Credentialing (CTC) Program Sponsor for the Designated Subjects (DS) CTE Credential. The CTE Credential Program evaluates CTE credential applications and makes credential recommendations to CTC as well as providing a series of sequenced coursework that prepares new CTE candidates to become effective teachers. The Preliminary CTE Credential is issued by the CTC for three years and authorizes the CTE candidate to teach one or more subjects in the industry sector named on the credential in grades twelve and below and in classes organized primarily for adults in career technical, trade or vocational courses. Your employing school district must determine, based on your work and educational experiences, which particular subjects you may teach within the industry sector. The available industry sectors and subjects within each sector are provided in your packet. Please read all materials in the Part I Credential and Program Requirements information packet before proceeding to the Part II Credential Application Forms packet. You should retain the Part I materials for your files. The Part II application forms with all required fees and documentation must be submitted to the OCDE for evaluation. To qualify for this program, teachers holding a clear multiple subject, single subject or education specialist teaching credential must have:

• An authorization to teach English learners • At least one year of teaching experience while holding the original credential • Two years of occupational experience in the specific industry sector for the CTE

credential they wish to obtain (Work experience based on qualifications set by CTC, approved alternatives or substitutions will qualify)

If the original teaching credential does not include an authorization to teach English learners or if the individual does not hold a separate English learner authorization (i.e. Clear CLAD/BCLAD Certificate, Certificate of Completion of Staff Development) then the individual must complete the coursework for the English learner authorization in addition to the other credential requirements.

Qualified candidates are only required to take the CTE Core course. The CTE Core course will be offered in an online class format during the fall, spring, and summer semesters. The required course must be taken during the first available semester after the credential recommendation letter is issued.

Within the three-year preliminary period, multiple subject, single subject or education specialist teaching credential approved candidates must verify one additional year of documented successful CTE teaching experience in the industry sector(s) listed on the

Orange County Department of Education Institute for Leadership Development

Career Technical Education (CTE) Teacher Credential Program

Revised: 8/1/16

CTE credential completed while holding a preliminary CTE credential to qualify for the clear CTE credential. It is strongly recommended that any CTE candidate lacking appropriate computer hardware and software or basic computer skills (including the ability to utilize the internet and email as well as download, print, and create PDF documents) should purchase the necessary equipment and complete a computer literacy course prior to applying for the CTE credential. Candidates will be provided continuous advisement and support throughout the CTE Credential Program by their OCDE instructor and program specialist. OCDE staff will work with candidate’s employing District/ROP who will provide a district “just-in-time” mentor to augment the support provided by the CTE Credentialing Program. Candidates must demonstrate competency in all Category II Program Standards by completion of the program in order to be recommended for the Clear CTE Credential. CTE candidates will also need to meet the Health Education for Teachers, CPR (Infant, Child and Adult), and U.S. Constitution requirements in order to apply for the Clear CTE Credential. Please contact Breanna Hart, CTE Administrative Assistant at 714-708-5898 or go to our website at http://www.ocde.us/CTE/Pages/default.aspx for additional information.

http://www.ocde.us/CTE/Pages/default.aspx

Revised: 8/1/16

PRELIMINARY CAREER TECHNICAL EDUCATION (CTE) CREDENTIAL REQUIREMENTS FOR MULTIPLE SUBJECT, SINGLE SUBJECT and EDUCATION SPECIALIST

CREDENTIAL HOLDERS Multiple Subject, Single Subject and Education Specialist Credential Holders must satisfy all of the following requirements in order to apply for the Preliminary Designated Subjects (DS) Career Technical Education (CTE) Credential: • Three years of work experience directly related to each industry sector to be named on the

credential (see appendix). One year equals a minimum of 1000 clock hours per calendar year. The experience may be full-time or part-time, paid or unpaid.

• At least one year of the work experience must be within the last five years or two years within

the last ten years immediately preceding the issuance of the preliminary credential. For purposes of meeting the recency requirement, any of the following (or a combination of the following) may be cumulated to total 1000 clock hours: work experience, college-level related coursework, non-college related coursework, occupational internship, or vocational teaching experience. (see CTC worksheet) Note: Candidates must be able to prove their experience to the CTC and their district/ROCP in order to teach specific subjects within the industry sector authorization.

• Completion of 48 semester units of postsecondary vocational training related to the industry

sector(s) named on the credential may be substituted for a maximum of two of the three years of required work experience. The coursework must be verified by official transcript and may be made on a pro rata basis up to the two-year maximum.

• Additionally, one of the following may be used as one year of work experience toward meeting

the three years of required experience: (1) possession of an advanced industry certificate related to the industry sector to be named on the preliminary credential, as determined by a Commission-approved CTE program sponsor or (2) one year of full-time general education teaching experience providing instructional services in preschool or grades K-12 earned in a public or private school of equivalent status.

• Required is unopened, official college transcripts verifying a degree above high school (AA, AS, BA,

BS, MA, MS, or Ph.D.), or a copy of high school diploma or GED Certificate. Foreign transcripts must be evaluated by CTC approved organizations only.

• Completed application forms for OCDE and CTC. • Processing fees for OCDE and CTC. Money orders only. No personal checks or cash.



Revised: 8/1/16

ORANGE COUNTY DEPARTMENT OF EDUCATION CTE TEACHER CREDENTIALING PROGRAM

MULTIPLE SUBJECT, SINGLE SUBJECT and EDUCATION SPECIALIST CREDENTIAL HOLDERS

As an approved Program Sponsor, The Orange County Department of Education recommends candidates to the Commission on Teacher Credentialing (CTC) for the preliminary Career Technical Education (CTE) Credential. Teachers holding a clear multiple subject, single subject or education specialist California teaching credential must have:

• An authorization to teach English learners • At least one year of teaching experience while holding the original credential • Two years of occupational experience in the specific industry sector for the CTE credential they

wish to obtain (Work experience based on qualifications set by CTC, approved alternatives or substitutions will qualify)

If the original teaching credential does not include an authorization to teach English learners or if the individual does not hold a separate English learner authorization (i.e. Clear CLAD/BCLAD Certificate, Certificate of Completion of Staff Development) then the individual must complete the coursework for the English learner authorization in addition to the other credential requirements.

Additionally, candidates must successfully fulfill the following requirements to obtain the clear Designated Subjects (DS) CTE Credential:

Must complete the required CTE Core course

Must have completed the Health Education for Teachers, CPR (Infant, Child and Adult), and U.S.

Constitution requirements. Must demonstrate competency in all Category II Program Standards by completion of the program

in order to be recommended for a clear CTE credential.

Must verify one additional year of documented successful CTE teaching experience completed while holding a preliminary CTE credential to qualify for the clear CTE credential.



Orange County Department of Education

Institute for Leadership Development Career Technical Education (CTE) Teacher

Credential Program

Program Flowchart MULTIPLE SUBJECT, SINGLE SUBJECT and EDUCATION SPECIALIST

CREDENTIAL HOLDERS

Phase One: Enrollment Phase Two: Program Courses Phase Three: Clear Requirements

Complete the Application Form and submit with $150.00

processing fee prior to the enrollment period beginning. Include the cashier’s checks

required for additional fees to the CTC.

Program Orientation Held face-to-face at OCDE and via webcast for out of

area candidates.

Candidates must have completed

Health Education for Teachers, CPR and U.S. Constitution Requirements

Fees paid to the institution providing

the coursework by the candidate directly. (Not covered by OCDE

tuition)

If approved, candidate will be sent C19

recommendation letter for employer.

OCDE works with candidate district/ROP to identify a DB

sheet and Just-in-Time Mentor and candidate begins

coursework.

Two (2) terms/ One (1) years of teaching experience occurs and employer verification of that experience is sent to OCDE.

CTE Core Course 75 hours

OCDE submits a recommendation for the

candidate’s Clear CTE teaching credential.

Revised: 8/1/16

COURSEWORK OVERVIEW


The OCDE Career Technical Education (CTE) Teaching Credential Program for multiple subject, single subject or education specialist includes:

• CTE Core Course – 75 hours

Total required program hours = 75 (Course fees $700.00) All courses are online.

The CTE Core Course is mandatory for all candidates who hold a clear multiple subject, single subject or education specialist California teaching credential. Candidates study essential themes, concepts, and skills related to the teaching profession, including knowledge of the history and traditions of CTE, its role in the curriculum of public education, and its current ethical issues. Candidates develop a professional perspective by examining contemporary education policies and teaching practices in relation to fundamental issues, theories and research in education. Instruction fulfills the competencies as identified by the California Commission on Teacher Credentialing (CCTC) Program Standard 13.

Portfolio: Candidates will assemble a culminating portfolio as part of the course.



Revised: 8/1/16

Career Technical Education Teacher Credential Program

PART II

APPLICATION FORMS FOR

MULTIPLE SUBJECT, SINGLE SUBJECT and EDUCATION SPECIALIST

CREDENTIAL HOLDERS



Revised: 8/1/16

Application Packet Checklist


Thank you for choosing our program. You may mail the completed packet to our office at the address below. Do not mail an incomplete packet as it will be returned to you. Please submit original transcripts and work verification letters as copies are not acceptable. If you have any questions, please call 714-708-5898. After choosing the appropriate application packet from the website, assemble packet in the following sequence:

1. Fees • Money order or cashier’s check payable to OCDE in the amount of $250.00: $50.00

processing fee $ 200.00 credited towards the first course (nonrefundable) • Money order or cashier’s check in the amount of $100 payable to the Commission on

Teacher Credentialing (CTC)

2. OCDE Program Application, Acceptable Use of Technology Agreement, Public Relations Media Request Form, Release of Information Permission Form and Intent to Complete all Requirements Form

3. CTC Form 41-4, Application for Credential Authorizing Follow directions on application. Complete items 1, 2, 4, 5 and 6 the “Oath and Affidavit” section.

4. Education Requirement Verification Submit unopened, official college transcripts verifying a degree above high school (AA, AS, BA, BS, MA, MS, or Ph.D.) or a copy of high school diploma/GED certificate. Foreign transcripts must be evaluated by CTC approved organizations only.

5. Work Verification Experience See Preliminary CTE Credential Requirements enclosure for qualifying requirements.

6. Licenses (if applicable, i.e. nursing, cosmetology, etc.)

7. Completed Request for Live Scan Service (electronic fingerprint transaction) signed by Live Scan technician. Only use the form 41-LS in this packet. If applicable or if not on file with the CTC.

Make a duplicate copy of your application for your files before submitting it to OCDE


200 Kalmus Drive Costa Mesa, CA 92626

ATTN: Breanna Hart



Revised: 8/1/16

OCDE Program Application

Social Security Number_______________________ Date of Birth____________________

Applicant’s Full Legal Name:

_____________________________________________________________________________ First Middle Last ____________________________________________________________________________

Mailing Address

____________________________________________________________________________ City State Zip Code ____________________________________________________________________________ Home Phone Work Phone Cell Phone E-mail_______________________________________________________________________ (Note: Please inform OCDE and CTC of any changes to your email address.) Do you hold other Credentials? Yes_____ No______ If yes, please list: ___________________________________________________________________ Type of Credential you are applying for (Check one): _______Preliminary CTE Credential (new three-year) _______Clear CTE Credential Industry Sector(s) ___________________________________________________________________ *For the list of possible teaching subjects, see the industry sectors list in the appendix. Teaching Assignment Have you been offered a teaching assignment with a school district or other educational agency? If so, please list all information below. If not, you must contact OCDE Credentialing Unit as soon as you are hired. _____________________________________________ ________________________________ School District (Agency) and Name of School County of Employment _____________________________________________ ________________________________ Mailing Address City, Zip Code __________________________ ________________ ________________ _____________ Name of Supervisor Telephone/Ext. FAX Email



Revised: 8/1/16

INTENT TO COMPLETE ALL REQUIREMENTS


LAST Name: ______________________________ FIRST Name: ______________________

I agree that: (1) I will inform OCDE if I change my email address. (2) I will have daily access to a computer and email. (3) I have computer literacy skills including the ability to utilize the internet as well as download, print, and create PDF documents I understand that: (1) The coursework must be started during the first semester after receiving my Preliminary CTE Credential recommendation. (2) I must hold a clear multiple subject, single subject or education specialist California teaching credential which includes an authorization to teach English learners, have at least one year of teaching experience while holding the original credential and two years of occupational experience in the specific industry sector for the CTE credential I wish to obtain. (Work experience based on qualifications set by CTC, approved alternatives or substitutions will qualify)

I certify that I understand the requirements that I must complete in order to clear the Preliminary CTE (Designated Subjects) Teaching Credential for which I am applying within the three-year preliminary period as outlined below.

Requirements: Credential Program Coursework:

• CTE Core Course • Portfolio

Health Education Requirements: • Approved Health Education for Teachers course • CPR card (valid during the three-year preliminary period) covering Adult, Child, & Infant CPR skills (no

online classes accepted) U.S. Constitution Requirement:

A two-semester or three-quarter unit course which includes “U.S. Constitution” in the course description on an official transcript or passage of an exam accepted by the CTC. Course options are listed on our website.

Teaching Requirement: • Successful teaching for one additional year of documented successful CTE teaching experience completed

while holding a preliminary CTE credential to qualify for the clear CTE credential. ______________________________________________ __________________________ Signature of Preliminary CTE Credential Applicant Date



Revised: 8/1/16

PUBLIC RELATIONS MEDIA RELEASE FORM

1. I hereby consent to and authorize the Orange County Department of Education (OCDE) to produce and use photographs, videos, and/or interview information about me for education e-news, promotional activities, and for the purpose of communicating information about OCDE.

2. I understand and agree that use of such information and images will be without any compensation to the candidate.

3. I understand and agree that the OCDE and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright in the recorded images.

I give permission to have my name, schoolwork, or picture published as stated above for general public viewing. Please do NOT include my name, schoolwork or picture when publishing materials available for general public viewing. Candidate’s Name: _____________________________________________________

Please Print

Candidate Signature: _____________________________________________________ Date: ________________________



Revised: 8/1/16


Career and Technical Education (CTE) Teacher Credential Program

RELEASE OF INFORMATION Permission/Release Form

I, ____________________________________, hereby consent and authorize for the Orange County Department of Education Credential Services Unit to release my name and contact information (restricted to phone numbers and/or e-mail address) to local school districts that have requested information for employment inquiries of available Designated Subject Credential educators in the local area. Print Name: _____________________________________ Signature: _______________________________________ Email: _________________________________________________Date: ________________________

Orange County Department of Education Institute for Leadership Development Career and Technical Education (CTE)

Teacher Preparation Program

USE OF TECHNOLOGY POLICY The County Superintendent of Schools encourages employees’ use of technological resources. This administrative regulation presents the obligations and responsibilities of employees and other authorized adults in the use of Orange County Department of Education technological resources. This regulation implements the Internet safety requirements of the Children’s Internet Protection Act (CIPA) to ensure eligibility for Universal Service (E-rate) discounts on Internet access and internal connection services. The employee or authorized user of Orange County Department of Education technological resources (user) is responsible for their proper use at all times. Users are expected to use technological resources to more effectively perform the duties and responsibilities of the operations and programs of the Orange County Department of Education. Users should be aware that computer files and communications over electronic networks, including e-mail and voice mail, are not private. Information maintained on technological resources may be required to be disclosed under the California Public Records Act. Technology systems are not routinely inspected, monitored, or disclosed; however, the County Superintendent of Schools or his/her designee may monitor technological resources, including e-mail and voice mail systems, at any time without advance notice or consent. If system passwords are used, they must be made known to the County Superintendent of Schools or his/her designee so that he/she may have backup access in exceptional cases, when required to meet time-dependent, critical operational needs. In compliance with Federal Communications Commission rules for CIPA, the executive director, Technology Research and Network Services, or designee, shall ensure that the Internet access of all Orange County Department of Education computers is regulated by a technology protection measure and that the operation of such measure is maintained. The technology protection measure shall continuously filter or block access to visual depictions that are obscene, child pornography, or harmful to minors. The executive director, Technology Research and Network Services, or designee, may disable the technology protection measure during use of a computer by an adult to enable access for bona fide research or other lawful purpose. No employee may permit minors to use computers with Internet access where the technology protection measure is not enabled. Use of Orange County Department of Education computers by minors is governed by Administrative Regulation No. 6163, Student Use of Technology.

Employees are authorized to use the technological resources of the Orange County Department of Education in accordance with the user obligations and responsibilities specified below.

1) Users shall keep personal account addresses, home addresses, telephone numbers, Social Security numbers, and other individually identifiable information private. They shall use the system only under their own user account.

2) Users shall not use technological resources to transmit records or confidential information about students, employees, or privileged matters of the Orange County Department of Education to anyone not legally entitled to receive it.

3) Users shall not use technological resources for commercial or political purposes, to encourage the use of drugs, alcohol, or tobacco, or to promote unethical practices or conduct any activity prohibited by law, Board policy, or administrative regulations.

4) Users shall not access, post, publish, transmit, or display harmful or inappropriate material, including visual depictions, in electronic form that is threatening, obscene, disruptive, sexually explicit, or child pornography, or that could be construed as harassment or disparaging of others based on race, color, ancestry, national origin, sex, sexual orientation, age, marital status, physical disability, mental disability, medical condition, religious creed, or political beliefs.

5) Users may only place copyrighted material, including multimedia, on the system with appropriate permission or user license. Users may download copyrighted material for their own use only in accordance with copyright laws.

6) Except as required in the course and scope of their job responsibilities, users shall not read other users’ mail or files; they shall not attempt to interfere with other users’ ability to send or receive electronic messages, nor shall they attempt to read, delete, copy, modify, forge, or fraudulently use other users’ mail.

7) Users shall not use Orange County Department of Education technology resources to commit acts of vandalism. Security problems, vandalism, or misuse of the network shall be reported to the network administrator. Vandalism includes, but is not limited to, hacking, intentionally uploading, downloading, transferring, or creating computer viruses and/or any malicious use of Orange County Department of Education technology equipment. Also included are any actions that attempt to harm or destroy equipment or materials, whether paper, microform, or electronically based, or data in any form of any other user. Public offenses related to computer crime are further defined in Penal Code section 502. User privileges may be canceled and/or the user may be subject to disciplinary or legal action in the event of violation of any conditions of applicable law, Board policy, or administrative regulation.

Revised: 8/1/16

Orange County Department of Education Institute for Leadership Development Career and Technical Education (CTE)

Teacher Credential Program

ACCEPTABLE USE OF TECHNOLOGY POLICY Acknowledgement Form

I have received a copy of the Acceptable Use of Technology policy. I understand that I am expected to comply with and abide by the policy. Print Name: _______________________________________ Signature: _________________________________________ Email: _________________________________________________Date: ________________________

FORM 41-4 (REV. 3/2016) 1

APPLICATION FOR CREDENTIAL AUTHORIZING PUBLIC SCHOOL SERVICE (For Privacy Act Notification see Application Instructions)

1. PERSONAL INFORMATION (type or print)

*Social Security or Individual Tax ID Number: *Date of Birth: (mm/dd/yyyy)

*Applicant’s Name:

First Middle Last

Former/Maiden Name(s): County or District of Employ (CA only):

*Address:

*City: *State: *Zip:

Home Phone: Work Phone: Message Phone:

*Email Address:

2. CREDENTIAL TYPE (choose only one type below) OPTIONS:

Substitute Permits (PT) English Learner Authorizations

BILINGUAL AUTHORIZATION – Specify LanguageSingle Subject (Secondary Teaching)

Specify Subject (If you are requesting more than one subject, enter it in Comments box.)

Specify World Language other than English (if applicable)

Term

Services Credentials

Term

Specify Other Health Services

Child Development Permits (PK)

Multiple Subject (Elementary Teaching)

Term

School-Age Emphasis

Designated Subjects (PW)

Subject(s) Term

Supplementary Authorization(s) (PJ)

Subject Matter Authorization(s) (PJ)

CTC Use Only

Education Specialist (Special Education) (If you are requesting more than one specialty area, enter it in Comments.)

Specify Specialty Area

Term Other Specialist Credentials

Added Authorizations (AASE)

CTC Use Only

IHE/County/District Use Only

Issuance Date:____________________________

Email

Address:_________________________

CCTC Use Only

IHE/County/District Use

Only

Issuance

Date:__________________

E-Mail Address:

________________

Mail application and payment (check or money order) to: Commission on Teacher Credentialing Certification Division 1900 Capitol Avenue Sacramento, California 95811-4213

Appeal:__________________

Route to: ________________

Commission Use Only: Fee Information

APP FP Other

* = Required Fields

http://www.ctc.ca.gov/credentials/leaflets/414-instructions.pdf

FORM 41-4 (REV. 3/2016) 2

4. PROFESSIONAL FITNESS QUESTIONS

Answers to the following questions are required. If you answer yes to any question, you must complete the corresponding Professional Fitness Explanation Form.

Before granting your application, the Commission will review, at a minimum:

Federal Bureau of Investigation criminal history (rap sheet)

California Department of Justice criminal history (rap sheet)

International database of teacher misconduct maintained by the National Association of State Directors ofTeacher Education and Certification (NASDTEC)

Previous reviews by the Commission

Complaints from others

Notifications from school districts

Teacher preparation test score violations

You must disclose misconduct, even if:

It happened a long time ago

It happened in another state, federal court, military or jurisdiction outside the United States

You did not go to court and your attorney went for you

You did not go to jail or the sentence was only a fine or probation

You received a certificate of rehabilitation

Your conviction was later dismissed (even if under Penal Code section 1203.4), expunged, set aside or thesentence was suspended

Warning: You will be required to sign your application under penalty of perjury; by doing so you are also stating:

Failure to disclose any information requested is falsification of your application and the Commission may rejector deny your application or take disciplinary action against your credential

3. CHILD DEVELOPMENT PERMIT RENEWAL SELF-VERIFICATION (CURRENT CHILD DEVELOPMENT PERMIT HOLDERS)

As the holder of a Child Development Permit (any level except the Associate Teacher Permit) you must complete a specificnumber of planned and approved professional growth activities for each five-year renewal. These activities must be recorded on the Professional Growth Plan and Record form. As the holder of a Child Development Permit choosing to self-verify completion of these requirements, you may be subject to an audit. The Commission reserves the right to request submission of these forms for auditing purposes any time within one year following submission of this application. If the Commission determines through its audit that you did not complete the professional growth requirements, your permit will not be renewed and you may be subject to adverse action on other credentials you currently hold. You must retain your Professional Growth Plan and Record form for one year following the submission of this application.

DECLARATION: I certify (or declare) that I have read the above and completed the following for this renewal of my clear credential:

I have completed __________ hours of professional growth activities

My Professional Growth Advisor is ___________________________________________ ____________________________ Advisor’s Name Advisor’s Phone Number

That you understand any and all instructions related to your application;

That the information you provide is true and correct;

The Commission may reject your application if it is incomplete and it will be delayed;

http://www.ctc.ca.gov/credentials/online-services/pdf/OA-EF.pdf

FORM 41-4 (REV. 3/2016) 3

a. Have you ever been:

dismissed or,

non-reelected or,

suspended without pay for more than ten days, or

retired or,

resigned from, or otherwise left school employment

because of allegations of misconduct or while allegations of misconduct were pending?

Yes No

b. Have you ever been convicted of any felony or misdemeanor in California or any other place?

You must disclose:

all criminal convictions

misdemeanors and felonies

convictions based on a plea of no contest or nolo contendere

convictions dismissed pursuant to Penal Code Section 1203.4

driving under the influence (DUI) or reckless driving convictions

no matter how much time has passed

You do not have to disclose:

misdemeanor marijuana-related convictions that occurred more than two years prior to this application, exceptconvictions involving concentrated cannabis, which must be disclosed regardless of the date of such aconviction.

infractions (DUI or reckless driving convictions are not infractions)

Yes No

c. Are you currently the subject of any inquiry or investigation by any law enforcement agency or any licensing agencyin California or any other state?

Yes No

d. Are any criminal charges currently pending against you?

Yes No

e. Have you ever had any credential, including but not limited to, any Certificate of Clearance, permit, credential,license or other document authorizing public school service, revoked, denied, suspended, publicly reproved, and/orotherwise subjected to any other disciplinary action (including an action that was stayed) in California or any otherstate or place?

Yes No

FORM 41-4 (REV. 3/2016) 4

f. Have you ever had any professional or vocational (not teaching or educational) license revoked, denied, suspended,and/or otherwise subjected to any other disciplinary action (including an action that was stayed) in California or anyother state or place?

Yes No

5. CHILD ABUSE AND NEGLECT MANDATED REPORTING

As a document holder authorized to work with children, it is part of my professional and ethical duty to report every instance of child abuse or neglect known or suspected to have occurred to a child with whom I have professional contact.

I understand that I must report immediately, or as soon as practicably possible, by telephone to a law enforcement agency or a child protective agency, and will send a written report and any evidence relating to the incident within 36 hours of becoming aware of the abuse or neglect of the child.

I understand that reporting the information regarding a case of possible child abuse or neglect to an employer, supervisor, school principal, school counselor, coworker, or other person is not a substitute for making a mandated report to a law enforcement agency or a child protective agency.

I understand that the reporting duties are individual and no supervisor or administrator may impede or inhibit my reporting duties.

I understand that once I submit a report, I am not required to disclose my identity to my employer.

I understand that my failure to report an instance of suspected child abuse or neglect as required by the Child Abuse and Neglect Reporting Act under Section 11166 of the Penal Code is a misdemeanor punishable by up to six months in jail or by a fine of one thousand dollars ($1,000), or by both that imprisonment and fine.

I acknowledge and certify that as a document holder, I will fulfill all the duties required of a mandated reporter.

I agree

6. EMPLOYING AGENCY INFORMATION

This section must be completed for all credential, certificate, and permit types where service is restricted to an employing agency.

County CDS Code _________________________________ School District CDS Code ______________________________

Charter Sc

hool/Non-Pub

lic School or Agency/Statewide Agency Name ____________________________________________

Applications for One-Year Nonrenewable Credentials, Provisional Internship Permits, Short-Term Staff Permits, Limited Assignment Permits, and Emergency Permits (except 30-Day or Prospective Substitute Teaching Permits), must be filed through the employing agency. Employers must have an annual Declaration of Need for Fully Qualified Educators on file with the Commission prior to the submission of any applications for Limited Assignment or Emergency Permits.

1) Personal information with correct SSN, date of birth, and email address filled in on page 12) Type of credential clearly marked on page 1 (use box below for additional subject/authorization requests)3) All Professional Fitness Questions marked Yes or No on pages 3 and 44) Read and agreed to your responsibilities as a mandated reporter5) Payment (check or money order attached to the front of this form). See Credential Leaflet CL-659 for fee

schedule.

Before submitting, check application for completeness:

dcrable

Typewritten Text

dcrable

Typewritten Text

dcrable

Typewritten Text

dcrable

Typewritten Text

FORM 41-4 (REV. 3/2016) 5

Comments/Additional Subject Requests:

Checks or money orders may be made payable to the Commission on Teacher Credentialing. The Commission does not accept cash payments. All application fees are non-refundable.

Applications submitted that are incomplete or without the appropriate fee included will not be processed and will be returned.

7. OATH AND AFFIDAVIT

I solemnly swear (or affirm) that I will support the Constitution of the United States of America, the Constitution of the State of California, and the laws of the United States and the State of California. I hereby certify (or declare) under penalty of perjury under the laws of the State of California that all the foregoing statements in this application are true and correct.

Date _________________ City ____________________________________________ County ____________________ State ________

SIGNATURE OF APPLICANT __________________________________________________________________________________________

Sample: Work Experience Verification Letter from Employer

Request current/former employers to write a letter verifying that you have worked in your occupation (not teaching) for at least three (3) years (1000 hours per calendar year). One of these three (3) years must be within five (5) years or two (2) years within ten (10) years of your credential application date. Letter must state your name, position, title, job duties, dates of employment, and full· or part-time status, including the number of hours worked per year.

[Write a "draft" letter for your employer so all information will be included, have the employer put your "draft" on company letterhead.) Letters must be on company letterhead, signed by your current/former supervisor or personnel office, and verifiable by telephone. Submit originals only- no copies.

(On Employer letterhead) Essential Automotive Supplies

425 Main Street Los Angeles, CA 90000

Date (Month/Day/Year)

Commission on Teacher Credentialing Sacramento, CA

To Whom It May Concern:

This letter is to verify the employment of John Doe, who worked for Essential Automotive Company as an Automotive Mechanic from February 6, 2005 until April15, 2008. He was a mechanic working full-time, at least 1,000 hours per year.

As an Automotive Mechanic, his duties were:

• general auto motive repair • diagnose defective engines • replace defective parts • tune up engines • replace brakes

Please contact me at (310) 555-6850 if you have any questions.

Sincerely,

Robert Richmond (Name of Supervisor) Owner (Position/Title)

(On Employer letterhead} ABC Computer Corporation

123 Main Street Los Angeles, CA 90000

Date (Month/Day/Year) Commission on Teacher Credentialing Sacramento, CA To Whom It May Concern: This letter is to verify the employment of Joanna Doe, who worked for ABC Corporation as a Computer Technician from February 6, 2005 until April 15, 2008. She was a computer technician working full-time, at least 1,000 hours per year. As a Computer Technician, her duties were:

• install applications • set up databases • set-up and use spreadsheets • desktop publishing • word processing • programming languages

Please contact me at (310) 555-6850 if you have any questions. Sincerely, Roberta Richmond (Name of Supervisor) Manager (Position/Title)

Sample: Work or Occupational Experience, Self-Verification

For self-employed or former employer not available (or job duties not listed), you must submit the following items:

a. A notarized self- verification letter from you in the format below. End with the following statement: "I

certify under penalty of perjury that the contents of this letter are true and correct to the best of my knowledge."

b. Five documents as back up to your notarized self- verification letter, which may include:

• Copy of tax form statement, business cards, advertising flyers, etc. • Current/former business license(s) or permit(s) within dates on letter. • Letters from former customers. The letter must state the jobs done and the length of the jobs. • Letters from suppliers, or other business associates (such as your accountant, lawyer), who can

verify your occupation.

Name 456 Main Street

Los Angeles, CA 90000

Name 425 Main Street

Los Angeles, CA 90000

Date (Month/day/year)

Commission on Teacher Credentialing Sacramento, CA

To Whom It May Concern:

This letter is to verify my employment, (YOUR NAME HERE),as a full time Office Worker with (NAME OF COMPANY). (NAME OF COMPANY) was closed and is no longer in business. I worked from 2005 to 2008, full-time at least 1,000 hours per year.

As an Office Worker my duties were:

• Filling, customer service, answering phones • Data entry • Completing reports, memos and letters

using Microsoft word • Processing account payables and

receivables • Provided other duties as necessary

Please call me at xxx/xxx-xxxx should you have any further questions

I certify under penalty of perjury that the contents of this letter are true and correct to the best of my knowledge.

Sincerely, (YOUR NAME HERE)

Date (Month/day/year) Commission on Teacher Credentialing Sacramento, CA To Whom It May Concern: This letter is to verify my employment, (YOUR NAME HERE), as a full- time Professional Dancer. I have worked and volunteer with various organizations such as (NAME OF COMPANIES). I worked from 2005 to 2008, full time at least 1,000 hours per year. As a Professional Dancer my duties were: • Professional dancer in Ballet, Jazz, Tap and

Modem Dance • Choreographer developing performing arts

programs • Assisting dancers in developing their skills • Preparation for performing arts plays and

recitals • Design and create "sets" for performing arts

production Please call me at xxx/xxx-xxxx should you have any further questions. I certify under penalty of perjury that the

contents of this letter are true and correct to the best of my knowledge Sincerely, (YOUR NAME HERE)

Fingerprinting Instructions

For The Commission on Teacher Credentialing

All Teaching Credential candidates must submit fingerprints as part of their first credential application. Fingerprints are sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI) through the Commission on Teacher Credentialing (CTC). Individuals who have received fingerprint clearance through a Public School District, other California Public Agencies, or in other states must repeat the process for this credential. Government agencies do not interchange fingerprint information.

"Live Scan" Electronic Fingerprinting

• Find a "Live Scan" service nearest you. See website

www.ag.ca.gov/fingerprints/publications/contact.htm and enclosed partial listing of agencies that offer "Live Scan" services. Call the agency to make an appointment. Most agencies charge between $68 - $84 for ''Live Scan" services. Fees for both the DOJ and FBI must be collected by the "Live Scan" operator when fingerprints are being submitted for the Commission on Teacher Credentialing.

• Fill out the third box of the attached "Request for Live Scan Service" form (41-LS Rev

04/15), typed or printed in black ink.

• You may use abbreviations on eye and hair colors. For example: BRN= brown, BLU=blue, BLK=black, BLND=blond,

GRN=green, GRY=gray, and HZL=hazel.

• If you have been hired by a school district or ROCP, you may ask your employer to complete the fifth box or you may do so.

• Fourth and sixth boxes need to be completed by "Live Scan" operator.

Note: If you have a California Teaching Credential or a Certificate of Clearance on file with the Commission on Teacher Credentialing (CTC), fingerprinting is not required. Do not submit. Please note that Community College fingerprinting will not suffice for Career Technical Education or Adult Credential applicants.

Please follow all instructions! Further information regarding Live Scan Instructions may be found on the CTC website at www.ctc.ca.gov under Information Leaflet CL271 (4/2016).

http://www.ag.ca.gov/fingerprints/publications/contact.htm

http://www.ctc.ca.gov/

REQUEST FOR LIVE SCAN SERVICE

Applicant Submission

A0281 License/Certification/Permit

TEACHER CRED 44340 EC

CASM TEACHER CREDENTIALING

1900 Capitol Avenue

Sacramento CA 95811-4213

03294Section 2

Section 1

Section 3

Section 4

Section 5

Section 6

Revised: 8/1/16

Career Technical Education Teacher Credential Program

Appendix



Industry Sectors This chart is intended to be a guide. Some of the occupations, such as “drafting,” can be applied to more than one Industry Sector. Program sponsors are encouraged to examine the work experience of the individual applying for a credential and determine which Industry Sector best applies. Assignments should be considered in the same way. The most important consideration is the background and the expertise of the individual. Effective September 1, 2014, some Industry Sectors have new titles, while some specific occupations moved into different Industry Sectors. See Coded Correspondence 14-08 for more information.

Industry Sectors Pathways Specific Occupations Agriculture and Natural Resources

• Agricultural Business • Agricultural Mechanics • Agriscience • Animal Science • Forestry and Natural Resources • Ornamental Horticulture • Plant and Soil Science

• Agriculture business management and marketing

• Agriculture mechanics • Animal care • Animal control • Animal production • Crop production • Floriculture and floristry • Forestry, natural resources and rural

recreation • Landscaping • Ornamental nursery operation

Arts, Media, and Entertainment

• Design, Visual, and Media Arts • Performing Arts • Production and Managerial Arts • Game Design and Integration

• Commercial art • Commercial photography • Game Design Occupations • Multimedia production • Performing arts occupations • Stage technology • Theatrical occupations

Building and Construction Trades

• Cabinetry, Millwork, and Woodworking

• Engineering and Heavy Construction

• Mechanical Systems Installation and Repair

• Residential and Commercial Construction

• Boat building • Carpentry • Civil Engineer • Concrete placing and finishing • Construction equipment operation • Construction inspection • Drafting occupations • Drywall installation • Electrician • Fire sprinkler installation • Floor covering installation • Foundry work • Furniture making, finishing and

refinishing • General contracting • Glazing • Hazardous materials occupations • Heating, air conditioning, and ventilation

installation and service • Heavy Equipment Operator

http://www.ctc.ca.gov/notices/coded/2014/1408.pdf

Building and Construction Trades (cont.)

• Interior maintenance (residential and commercial)

• Lathing • Masonry • Mechanical Engineer/Technician • Millwork and cabinet making • Motor sweeper operator • Painting-construction • Pipefitting and steam fitting • Plastering • Plumbing • Pool and spa service • Refrigeration installation and

maintenance • Residential and commercial repair and

remodeling • Roofing • Sheet metal fabrication • Structural and reinforcement ironwork • Structural pest control • Tile setting • Upholstering • Welding • Woodworking

Business and Finance • Business Management • Financial Services • International Business

• Accounting occupations • Auditor • Banking • Business Computing Specialist • Business management • Chief Financial Officer • Customs Inspector/Broker • Export Sales • Financial management and services • Human Resources Specialist • Income tax preparation • Insurance occupations • International Business • Investment Consultant • Legal office occupations • Office occupations • Personnel administration occupations • Purchasing Agent • Secretarial/stenography occupations • Tax preparation specialist • Small business ownership and/or

management

Education, Child Development, and Family Services

• Child Development • Consumer Services • Education • Family and Human Services

• Child care • Child Care Psychologist • Consumer Services • Counselors • Education Administrators • Elderly care services (non-medical) • Family and human service occupations • Librarian • Personal Financial Advisor • Preschool Teacher • Social Outreach Director • Teacher • Teacher aide

Energy, Environment, and Utilities

• Energy and Power Technology • Environmental Resources • Telecommunications

• Air Quality Technician • Climatologist • Control system maintenance and repair • Electrical power distribution • Electrician • Electronic consumer products service • Electronics assembly • Energy Auditor • Energy Engineer • Energy, environment and resource

manager/technician • Environmental Biologist/Scientist • Hybrid microelectronics • Hydroelectric plant operations • Industrial electronics • Marine power plant maintenance and

repair • Solar Occupations • Telecommunications Technicians • Water treatment

Engineering and Architecture

• Architectural Design • Engineering Technology • Engineering Design • Environmental Engineering

• Air Pollution Control Engineer • Architect • City Planner • Drafting occupations • Engineering occupations • Environmental Specialist • Field Engineer • Manufacturing Design Engineer • Mechanical/Electrical Drafting • Robotics • Structural Designer • Surveying

Fashion and Interior Design

• Fashion Design, and Merchandising

• Interior Design, Furnishings, and Maintenance

• Personal Services

• Barber* • Clothing, alteration and repair • Cosmetologist* • Esthetician* • Fabric maintenance services • Fashion Buyer • Fashion design • Fashion manufacturing (factory and

custom) • Fashion merchandising • Interior Buyer • Interior design • Kitchen and Bath Specialist • Makeup Artist • Jewelry design, fabrication, and repair • Manicurist* • Merchandising Manager • Pattern Maker • Set Decorator • Textile design • Textile production and fabrication • Upholstering

Health Science and Medical Technology

• Biotechnology • Patient Care • Healthcare Administrative

Services • Healthcare Operational Support

Services • Public and Community Health • Mental and Behavioral Health

• Athletic trainer • Biomedical equipment technician • Biomedical Engineer • Biomedical Research and Development

Specialist • Central Service Technician • Clinical Data Specialist • Clinical Lab Technologist/scientist • Clinical Simulator Technician • Forensic Pathologist • Community Health Professional • Geneticist • Diagnostic Technician • Dental Assistant • Dental Hygienist • Dental Lab Technician • Geriatric Technician • Health Care Administrator • Health Education Specialist • Health Information Management • Technician/Technologist • Massage Therapist • Materials Manager • Medical/Clinical Assistant • Mental health professional • Medical Sonographer

Health Science and Medical Technology (cont.)

• Nutritionist/Dietician • Outreach Coordinator • Phlebotomist • Physician’s Assistant • Physical Therapy

Technician/Technologist • Prosthetic Technician/Technologist • Psychiatric Technician/Psychologist • Public health professional • Nurse (RN/LVN/NP) • Radiological Technician • Rehabilitation Technologist/Therapist • Respiratory Technologist/Therapist • Sports Medicine Specialist • Ultrasound Technician

Hospitality, Tourism, and Recreation

• Food Science, Dietetics, and Nutrition

• Food Service and Hospitality • Hospitality, Tourism, and

Recreation

• Amusement and theme park occupations • Customer service representative related to

amusement, theme parks, hotel and lodging, and restaurant and food service establishments

• Dietetics and nutrition service • Event and conference planning • Executive Chef • Food and beverage production and

preparation • Food and beverage services • Food scientist • Hotel and lodging occupations • Recreation and sports entertainment • Registered Dietitian • Restaurant Management

Information and Communication Technology

• Information Support and Services Networking

• Software and Systems Development

• Games and Simulation

• Big Data Administration • Computer and Information Systems • Computer Programming • Computer Sciences • Computer User Support • E-Business/E-Commerce • Game Production • Information Management • Information Security • Information Systems and Operations • Multimedia Production • Networking Engineer • Network Installation and Operation • Network Support and Maintenance • Robotics

Information and Communication Technology (cont.)

• Social and New Media Production and Management

• Software and Applications Developer • Web and Mobile Application Production

Manufacturing and Product Development

• Graphic Production Technologies

• Machining and Forming Technologies

• Welding and Materials Joining • Product Innovation and Design

• Animator • CAD/CAM Specialist/Designer • Commercial Photographer • Commercial/Industrial Designer • Computer-assisted manufacturing • Computer Numerical Control (CNC)

Operations • Cutter • Digital/Graphic Artist • Drafting occupations • Electronics assembly • Electronic publishing • Fitter • Industrial ceramics manufacturing • Machine tool operation and machine shop • Manufacturing Engineer • Metal fabrication • Material/Supply Management • Model Maker • Plastics and composites manufacturing

occupations • Printing and graphics occupations • Product development, testing and

demonstration • Production process/management • Quality Assurance • Robotics • Technical illustration • Tool and die making • Waterfront manufacturing • Welder • Welding Inspection • Welding Engineer

Marketing, Sales, and Services

• Marketing • Professional Sales • Entrepreneurship/Self-

Employment

• Advertising Representative/Manager • Business Computer Specialist • Business Owner • Fashion Buyer • Floristry • Insurance Agent/Broker • International trade • Marketing • Market Research Analyst • Office Occupations • Public Relations Specialist

Marketing, Sales, and Services (cont.)

• Real estate • Retail occupations • Small business ownership and/or

management • Small Business Repair and Maintenance • Travel Agent • Various Professional Sales Occupations

Public Services • Public Safety • Emergency Response • Legal Practices

• Court reporting • Cyber Security • Emergency Medical Technician • Emergency Response Dispatcher • Fire control and safety • Fire fighting • Forester • Investigator/Law Librarian • Law enforcement occupations • Legal occupations (deletion of word to

expand options) • Loss Prevention Specialist • Paralegal • Protective and security services • Wildland fire services

Transportation • Operations • Structural Repair and

Refinishing • Systems Diagnostics and

Service

• Airframe and power plant mechanics • Automobile detailing • Automotive body repair and refinishing • Automotive brake installation and repair • Automotive electrical systems service and

repair • Automotive heating and air-conditioning

service • Automotive mechanics/technician • Automotive parts counterperson • Automotive suspension and steering

repair • Automotive transmission and transaxle

service and repair • Avionics • Bicycle repair • Claims Adjuster • Container Crane Operator • Diesel equipment mechanics • Dispatcher • Distribution Manager • Electric motor repair • Engine performance technician • Heavy equipment maintenance and repair • Industrial maintenance

and repair Production,

Planning, and Expediting Specialist

• Railroad operations • Small engine service and repair • Transportation

occupations, travel services

• Truck and bus driving • Warehousing

Note: specific occupations marked with an asterisk (*) require a state license outside the purview of the Commission.

Commission on Teacher Credentialing October 2015

The initial design and concept for this worksheet is attributed to Eileen Becker and Jeff Schmidt from the Santa Clara County Office of Education

DESIGNATED SUBJECTS CAREER TECHNICAL EDUCATION TEACHING CREDENTIAL – EXPERIENCE REQUIREMENT WORKSHEET

Teacher _____________________________ District ___________ School ___________________ Industry Sector _______________________ Date ____________________

Work Experience Requirement for the Three-Year Preliminary CTE Credential: “Three years of work experience directly related to each industry sector to be named on the credential.”

How the work experience requirement may be fulfilled: 3 Years Working in the Industry Sector:

BUT May Use Alternatives for recency Requirement

AND May substitute up to 48 semester units of postsecondary career-technical training related to the Industry Sector for a maximum of 2 of the 3 years of work experience

OR May substitute an Advanced Industry Certificate related to the Industry Sector for 1 Year of Work Experience OR

A year = 1000 or more hours - May be paid or

volunteer - May be part-time or full-

time* - May be self-employed or

avocational**

May substitute one year of full-time general Ed K-12 teaching experience in a public or private school for 1 Year of Work Experience

Recency of work experience: 1 year within last 5 years

OR 2 years within last 10 years

For recency requirement, any of the following may be cumulated to total 1000 clock hours: - Work experience - College-level related or non-

related course work - Occupational internship - Career-technical teaching exp

IMPORTANT: SUBSTITUTIONS SHOWN ABOVE MAY BE USED TO SATISFY UP TO 2 YEARS OF WORK EXPERIENCE, BUT AT LEAST 1 YEAR (1000 HOURS) MUST BE ACTUAL WORK EXPERIENCE IN THE INDUSTRY SECTOR

* If employment was less than full-time, an accounting of the number of hours the applicant was employed is required ** Requires a statement, signed by the applicant under penalty of perjury, verifying experience and substantiated in writing by other person(s) with first-hand knowledge of the

applicant’s self-employment or avocation.

Documents

Career Technical Education Teaching Credential … Holders Application.pdfmultiple subject, single subject and education specialist credential holders Thank you for your interest in