CLASSIFIED EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYER PERSONAL INFORMATION

Transcription

1 CLASSIFIED EMPLOYMENT APPLICATION Harney County School District #3 Burns High School 550 North Court Avenue Burns Alternative School Burns, Oregon Hines Middle School Phone (541) Henry L. Slater Elementary School Fax (541) Monroe School AN EQUAL OPPORTUNITY EMPLOYER PERSONAL INFORMATION DATE AVAILABLE FOR WORK TODAY S DATE mo day yr mo day yr NAME OTHER NAMES USED MAILING ADDRESS PHONE Street Address City State Zip Code SOCIAL SECURITY NO. RETIREMENT NO. POSITION YOU ARE APPLYING FOR (CHECK ALL THAT APPLY) Para Professional Bus Driver Food Service Custodial/Maintenance Office Other Specify Hours you wish to work Full Time Part Time Substitute

2 Personal and Professional References Please list at least two personal references, and two professional references. Do not list relatives Phone

3 EMPLOYMENT RECORD Previous Employment: Give information for your most recent employer s. List most recent employer first. 1. Dates From To Former Employer Phone of Supervisor 2. Dates From To Former Employer Phone of Supervisor 3. Dates From To Former Employer Phone of Supervisor 4. Dates From To Former Employer Phone of Supervisor 5. Dates From To Former Employer Phone of Supervisor Is there any reason we cannot contact the above employers? YES NO

4 EDUCATIONAL TRAINING NAME/ADDRESS OF SCHOOL LOCATION DATES INCLUSIVE D L HIGH SCHOOL COLLEGE/UNIVERSITY BUSINESS COLLEGE MILITARY/OTHER SCHOOLS OR TRAINING Do you speak any other language than English? do you speak? Do you have any computer experience? If so, what other foreign language If so, please explain.

5 APPLICATION PROCESS Candidates may be invited for a personal interview only if positions for which they are qualified are anticipated. The administration reserves the right to decide who will be interviewed for any vacancies. INFORMATION RELEASE I acknowledge that inquiries may be made to obtain job-related information from my previous employers, whether or not they are listed on the attached application and that similar inquiries may be directed to the persons listed as personal references as well as to any other individual who know me. I further acknowledge that Harney County School District #3 may, at its discretion make inquiries of law-enforcement agent the department of motor vehicles, credit bureaus and educational institutions, as well as initiate investigations by private persons for the purpose of verifying information supplied by me or to obtain additional information. I authorize such investigation and the giving and receiving of any information requested by the school district and I release from liability any person giving or receiving any such information. I affirm that all information provided by me on this application is true and complete. I understand that if any part of the information is false or misrepresented (including omission of information called for), my application will not be considered. If I am hired by Harney County School District #3 and any information is found to be false, that will be sufficient grounds for immediate dismissal. A photocopy of this release shall be as effective as the original. Applicant s Signature Date EQUAL OPPORTUNITY Harney County School District #3, an equal opportunity employer, complies with provisions of the various civil rights laws, such as the Fair Employment Practices Act, Title IX Regulations and Section 504 of PL in employment and educational programs and activities. DRUG-FREE WORKPLACE The District is committed to maintaining a drug-free workplace and strictly complies with the Drug-Free Workplaces Act of 1988 and the Drug-Free Schools and Communities Act of Drug test mandatory. AMERICANS WITH DISABILITIES ACT Reasonable accommodations for the application and interview process will be provided upon request and as required in accordance with the Americans with Disabilities Act of Disabled person may contact Dr. Marilyn McBride, Superintendent at (541) for additional information or assistance. Speech/hearing impaired persons may contact the District for assistance through the Oregon Relay at

6 DO NOT WRITE IN THE SPACE FOR OFFICE USE ONLY DATE APPLICATION RECEIVED POSITION RECOMMENDED FOR YEARS EXPERIENCE ALLOWED SALARY STEP STARTING SALARY SIGNATURE OF ADMINISTRATOR DATE COMMENTS