Parkway Local Schools
Certified Employment Application
Applicant Information
Full Name: Date:
Last
First MI
Address: Street Address Apt/Unit #
City State Zip Code
Phone: E-Mail Address:
Date Available: Social Security No: Desired Salary: $
Position Applied for:
Yes No Yes No
Are you a citizen of the
Have
you ever worked for this school?
May we contact your present employer?
Can you travel if a job requires it? Are you on layoff and subject to recall?
Have
you ever been convicted of a felony? Will you submit to a drug screening test?
If
yes, explain
SPECIAL SKILLS AND QUALIFICATIONS
Summarize special skills and qualifications acquired from employment or other experience:
Education
|
|
High School |
College/University |
Graduate/Professional |
|
School Name |
|
|
|
|
Years Completed: (Circle) |
9 10 11 12 |
1 2 3 4 |
1 2 3 4 |
|
Diploma/Degree |
|
|
|
|
License/Certificate |
Number |
Subjects |
Expiration Date |
|
Describe Specialized Training, Apprenticeship, Skills, and Extra-Curricular Activities |
|
|
|
Employment Experience
Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.
|
Employer |
Address |
Telephone
Number |
Position
and Status: FT/PT/Temp |
|
|
Describe
duties: ____________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ |
||||
|
Dates
Employed: From: To: |
Hourly
Rate/Salary Starting: Final: |
Name/Title
of Supervisor |
Reason
for Leaving |
|
|
Employer |
Address |
Telephone
Number |
Position
and Status: FT/PT/Temp |
|
|
Describe
duties: ____________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ |
||||
|
Dates
Employed: From: To: |
Hourly
Rate/Salary Starting: Final: |
Name/Title
of Supervisor |
Reason
for Leaving |
|
|
Employer |
Address |
Telephone
Number |
Position
and Status: FT/PT/Temp |
|
|
Describe
duties: ____________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ |
||||
|
Dates
Employed: From: To: |
Hourly
Rate/Salary Starting: Final: |
Name/Title
of Supervisor |
Reason
for Leaving |
|
If you need additional space, please continue on a separate sheet of paper.
Additional Information
Please
present any additional information concerning your work objective, interests,
and experience which will be helpful in evaluating your qualifications. Include business/professional organizations,
honors, etc. You are not required to
divulge any information which discloses race, national origin, color, religion,
citizenship, age (40 or over), sex, pregnancy, physical or mental disability,
union involvement, or membership in any other protected class.
References
Include
only individuals familiar with your work ability. Do not include relatives.
|
Name |
Address |
Phone |
Occupation/Title |
|
Name |
Address |
Phone |
Occupation/Title |
|
Name |
Address |
Phone |
Occupation/Title |
Disclaimer and Signature
Effective 10/15/1993, all applications for employment for positions with the Parkway
Local Schools shall include the following information:
· Employment application information/release
· Application form
Additionally, all persons to be employed after
I acknowledge being informed that, as a
precondition to employment, in the position for which I am applying, I must in
accordance with Ohio law both provide a set of fingerprints and satisfactorily
pass a criminal records check if I am to be considered for employment.
I represent that all information
furnished in connection with this application is true and accurate to the best
of my knowledge. I further recognize
that, should the employer discover that I have falsified any such information, I will not be hired or if already hired, will
be subject to termination from employment on that ground.
By signing, I grant permission to Parkway
Local Schools to contact any and all references.
Applicant
Signature: Date:
The Board of
Education does not discriminate on the basis of race, color, religion, national
origin, sex,
disability, or age in
its programs and activities, including employment opportunities.
3/06