APPLICATION FOR SUPPORT STAFF POSITION

THE EASTON SCHOOL DEPARTMENT DOES NOT DISCRIMINATE IN THE OPERATIONS OF ITS EDUCATIONAL AND EMPLOYMENT POLICIES AND WILL HONOR ALL APPROPRIATE LAWS RELATIVE TO DISCRIMINATION.

Date ______________________________ Social Security Number________________

Name _______________________________________________ Date of Birth____________

Address_______________________________________________

_______________________________________________Phone____________________

Position Applying for: ___________________________________________________________

EXPERIENCE: Please list all previous experience, starting with the most recent job held.

Employer Position/Duties Dates Employed

________________________________________________________________________________________

EDUCATION: Transcripts, including grades, from all college(s)/university(s) attended must be provided. It is essential that this section be completed accurately.

School Attended Address Completed/Graduated Major

______________________________________________________________________________

With what office machines are you familiar?__________________________________________

_____________________________________________________________________________
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REFERENCES: Please provide three (3) references, who are not related to you, who are familiar with your work as a teacher, substitute or who know of your experience working with youth.

Name Address Telephone

BACKGROUND:

Have you ever been disciplined, discharged, or asked to resign from a prior position? Yes ___ No ___

Have you ever resigned from a prior position after a complaint had been received against

you or your conduct was under investigation or review? Yes ___ No ___

Has your contract in a prior position ever been non-renewed? Yes ___ No ___

Have you ever not been nominated for re-employment in a prior position or ever had your

nomination for re-employment not be approved? Yes ___ No ___

Have you ever been charged with or investigated for sexual abuse or harassment of another

person? Yes ___ No ___

Have you ever been convicted of a crime (other than a minor traffic offense)? Yes ___ No ___

Have you ever entered a plea of guilty or “no contest” (nolo contendere) to any crime (other

than a minor traffic offense)? Yes ___ No ___

Have you ever had a professional license or certificate suspended or revoked in any state,

or have you ever voluntarily surrendered, temporarily or permanently, a professional license

or certificate in any state? Yes ___ No ___

Has any court ever deferred, filed or dismissed proceedings without a finding of guilty and

required that you pay a fine, penalty or court costs and/or imposed a requirement as to your

behavior or conduct for a period of time in connection with any crime (other than a minor

traffic offense)? Yes ___ No ___

If you have answered YES to any of the previous questions, provide full details below including, with respect to court actions, the date, offense in question, and the address of the court involved. Attach additional sheets if necessary. Conviction or other disposition of a crime is not necessarily an automatic bar to employment.

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SIGNATURE:

My signature below constitutes authorization to check my employment history, including without limitation, criminal arrests and conviction record checks, reference checks, and release of investigatory information possessed by any state, local, or federal agency. I further authorize those persons, agencies, or entities that the Easton School Department contacts in connection with my employment application to fully provide the Easton School Department with any information on the matters set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the Easton School Department, its agents and officials or against any provider of such information.

I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include board members, administrators, other staff, and members of the community. I give my consent to this disclosure.

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Signature Date