Nevada School District

Classified Application for Employment

 

We consider applications for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.

 

Date of Application:  _______________                   Position Applying for:  __________________

Available for work (when) ____________           Building/Grade:  _______________________

 

 

Name: _____________________________________________________________________

                    (Last)                                                                  (First)                                                      (Middle)

Address:  ___________________________________________________________________

               City __________________  State____  Zip  __________                   How long?  _____

 

Telephone No.  _______________________    Social Security No. ______________________

 

Have you ever been employed by Nevada School District?  _____  When?  ______________

 

 

Name of Relative(s) working here_______________________________________________

 

In case of emergency notify____________________________________________________

                                                Name                                                      phone number                             Relationship

 

Are you presently employed?   _______           Present employer ______________________

 

Date of Health Card  ____________________

 

Education and/or training

 

          High School (Circle highest grade completed)             9        10      11      12   GED

          Name/Location of high school ____________________        Year Graduated ______

 

          College (Circle number of years completed)                1        2        3        4

          Name of college   ___________________________   Cumulative Hours Earned _____    

          or  Degree(s) __________________________________________________________

           

          Paraprofessional Assessment:  Date Passed______________    Score _____________

 

          Other (describe type and extent of other)  ___________________________________

          ______________________________________________________________________

 

License(s) or certificate(s) held __________________________________________________

 

Special skills or abilities that prepare you for this work  ______________________________

___________________________________________________________________________

___________________________________________________________________________

Note:  The applicant should exercise the greatest care in preparing this form.  Information given herein becomes a legal part of the contract in case of election.  Please do not omit any item.

 

Work experience (job title, responsibilities, duties, etc…)

Begin with current position or with last one held, then next to last, etc.

 

Position/Duties                         Employer                                                From        To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References:  (List three.  Do not include former employers.)

 

Name                                      Address                                                          Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health

  Condition of health (circle one)               Excellent                Good                     Fair

 

  Do you have any disabilities that would interfere with the efficient discharge of your duties

  in the position being applied for (circle one):               Yes              No

 

  Have you ever been convicted of a crime?  _________  If the answer is yes, please explain: 

 

___________________________________________________________________________________________________

 

___________________________________________________________________________________________________

-  -  -  -  -  -  - -  -  -  -  -  -  - -  -  -  -  -  -  - -  -  -  -  -  -  - -  -  -  -  -  -  - -  -  -  -  -  -  - -  -

 

IF APPLYING FOR BUS DRIVER –

Driver’s License Number ____________________________________                   Expiration Date_____________

Do you have a CDL with PS endorsement?  ____   Number_________________  Expiration Date_____________

Have you ever driven a school bus?  ____  If so, for whom? _________________________________________

How many years?  ____  List other driving experiences _____________________________________________

Have you ever had to pay a fine for a traffic violation?  ______  If the answer is yes, please explain what the violations was, when and where it occurred:  

 

 

 

 

 

Have you ever been convicted of a felony, filed for bankruptcy, or are you now under indictment or information for a criminal offense?  

 

YES

 

 

No

 

 

If yes, give details:

 

 

Have you ever been discharged or asked to resign from any position(s)?        (List each and every employer.)

 

YES

 

 

No

 

 

If yes, give details:

 

 

Have you ever contracted with a school district but had your employment terminated?

 

YES

 

 

No

 

 

If yes, give details:

 

 

I authorize investigation of all statements contained in this application.  I understand misrepresentation or omission of facts called for is cause for dismissal without notice at any time during my employment.

 

I agree, if employed, to follow all rules and regulations of the Nevada School District.

 

I agree to promptly notify the Nevada School District of any changes including address or phone number(s) during my employment.

 

By my signature, I hereby give the school administration approval to obtain a moving vehicle report on my driving record from the state police records and local law enforcement records to verify my traffic record, as well as obtaining background check information.

 

I certify that the information I have provided to the foregoing questions is true and correct and that no attempt has been made to conceal pertinent information.  I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal.

 

I authorize my former employers and personal references to provide any information that they may have regarding me, whether or not it is in my personnel file.  I hereby release them and their company or school district or its employees or anyone from all liability for divulging same.

 

___________________________________________

Signature                                           Date

 

We will need a copy of your driver’s license, social security card and health card (showing you have had a TB skin test within the last three months).  We can make copies of these documents for you in our office.

 

If you do not have your health card indicating you have had a TB skin test, then you will need to obtain one and bring it in for us to make a copy.  The Health Department does TB testing on Monday, Tuesday, Wednesday and Friday  of each week.

 

Arkansas Act 1314 of 1997 requires criminal background checks as a condition at initial employment for local school districts. 

 

Forms necessary for the background check may be picked up at the Superintendent’s office.  The total cost is $44.25 to obtain the background check.  You will need two checks or money orders; one in the amount of $19.25 and the other in the amount of $25.00.  Both should be made out to the Arkansas State Police.