GRUNDY COUNTY BOARD OF EDUCATION
SUPPORT PERSONNEL APPLICATION FOR EMPLOYMENT
POSITION APPLYING FOR _______________________DATE____________________
Name________________________________________________________________________________
Address______________________________________________________________________________
(Street/P.O. Box) City State Zip
Telephone Number: (Home) _________________________ (Work)
______________________________
Are you eligible to work in the United States? __Yes __No Social Security Number
_________________
Have you been convicted of a felony? __Yes __No
If yes, explain _______________________________
_____________________________________________________________________________________
Have you ever worked in our system? ______Yes _______No
If yes, indicated what capacity:
____________________________________________________________
If yes, indicate dates (beginning and end) of employment:
_______________________________________
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Circle highest grade completed in each category:
|
High School |
Technology, Trade, Industrial Program(s) |
College |
Graduate School |
|
7 8
9 10
11 12
GED |
Certificate Licensure |
1 2
3 4
Degree |
1 2
3 4
5 6 |
High School Attended:
_______________________________________________________________________
Name & Address
Professional, Technology, Trade, Industrial Programs:
______________________________________________
Name & Address
________________________________________________________________________________________
Dates
Certificate/
License/ Bus License Number
College Attended:
_________________________________________________________________________
Name & Address
__________________________________________________________________________
Dates
Major
Credits or Degree
Please List all employment for the past fifteen (15) years, starting with
the most recent:
From_____________To_____________Employer_________________________________________________
Address____________________________________________Telephone_______________________________
Job Title_______________________________ Major
Duties________________________________________
From_____________To_____________Employer_________________________________________________
Address____________________________________________Telephone_______________________________
Job Title_______________________________ Major
Duties________________________________________
From_____________To_____________Employer_________________________________________________
Address____________________________________________Telephone_______________________________
Job Title_______________________________ Major
Duties________________________________________
From_____________To_____________Employer_________________________________________________
Address____________________________________________Telephone_______________________________
Job Title_______________________________ Major
Duties________________________________________
From_____________To_____________Employer_________________________________________________
Address____________________________________________Telephone_______________________________
Job Title_______________________________ Major
Duties________________________________________
From_____________To_____________Employer_________________________________________________
Address____________________________________________Telephone_______________________________
Job Title_______________________________ Major
Duties________________________________________
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List two professional/ work references:
Include at least one employer from a position held within the last five
years. They Grundy County
Department of Education reserves the right to contact your references at any
time after your application is received.
Name____________________________________ Work Relationship
________________________________
Address_______________________________________
Telephone___________________________________
Name____________________________________ Work Relationship
________________________________
Address_______________________________________
Telephone___________________________________
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The following statement is part of the application.
Read carefully before signing.
I hereby authorize representatives of the Grundy County Department of Education
to obtain information about me including, but not limited to, verification of
education, investigation of present and past employment, and review of criminal
convictions. I release the Grundy
County Department of Education and its representatives from liability for
seeking such information and all sources for furnishing such information.
I affirm that all statements on this application are true and accurate
and understand that omissions and/ or false or misleading statements made by me
on this application will be sufficient cause for rejection of my application or
terminations of my employment. I
acknowledge that the Grundy County School System is a drug-free system;
therefore, any unlawful manufacture, distribution, possession, and/ or use of
tobacco and/or tobacco products, alcohol or illicit drugs on any school site or
property owned or controlled by the Grundy County Department of Education or
during any activity of the Grundy County School System is subject to applicable
school, state, and general laws.
The Grundy County School System does not discriminate or permit discrimination
against any person or group of persons on the grounds of race, color, religious
creed, age, marital status, national origin, sex, mental retardation, or
physical disability.
Applicant’s Signature
______________________________________ Date ___________________________