All applicants for certification shall submit the following:
(1) An affidavit from the applicant indicating that he or she has not been convicted of any crime or a complete disclosure of all arrests and subsequent dispositions of such arrests. In the event of a conviction for any arrest, the applicant shall state reasons why such conviction does not reflect adversely on the requirement to possess good moral character and be personally fit.
(2) An affidavit from the applicant that he or she has no history of serious behavioral problems or a complete disclosure of the nature and status of all such problems, including the names and addresses of health practitioners who have treated the applicant within the past ten years and an executed consent form permitting the superintendent of public instruction to contact and consult with such health practitioners and for such health practitioners to fully disclose medical information related to such behavioral problems.
(3) An affidavit from the dean of the college or school of education or one or more officials designated by such dean, or, if none, by the college or university president, where the applicant completed his or her approved preparation program, that indicates that a designated college or university official has contacted several faculty members who personally know or knew the applicant and has no knowledge of any relevant information related to the applicant's character or fitness that would adversely affect the applicant's ability to serve in a certificated role or a statement from such affiant of the reasons why it is not possible to make such an affidavit.
(4) If the affidavit described in subsection (3) of this section is impossible or impractical to obtain, the applicant shall submit to the superintendent of public instruction the following:
(a) A complete employment history, including the names, addresses, and phone numbers of the immediate supervisor of such applicant when an employee; and
(b) The names, addresses, and phone numbers of three character references who are not related to the applicant.
(5) If the applicant holds or has held a certificate in any other state, such applicant shall prepare one of the following affidavits for each such state:
(a) An affidavit that such certificate has not been suspended, surrendered, or revoked. The superintendent of public instruction shall determine the status of certificates held by applicants in any other state to find if such certificates have been suspended, surrendered or revoked.
(b) An affidavit which shall fully disclose the reasons for the suspension, surrender, or revocation of the certificate. Such affidavit shall be submitted directly to the superintendent of public instruction.
[WSR 06-02-051, recodified as § 181-79A-155, filed 12/29/05, effective 1/1/06. Statutory Authority: RCW
28A.410.010. WSR 03-04-022, § 180-79A-155, filed 1/27/03, effective 2/27/03; WSR 01-09-006, § 180-79A-155, filed 4/5/01, effective 5/6/01. Statutory Authority: RCW
28A.410.010 and
28A.305.130 (1) and (2). WSR 99-23-023, § 180-79A-155, filed 11/9/99, effective 12/10/99. Statutory Authority: RCW
28A.305.130 (1) and (2),
28A.410.010 and
28A.150.220(4). WSR 99-01-174, § 180-79A-155, filed 12/23/98, effective 1/23/99.]