Para Application
SY 21-22 Interlocal 619
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Name: (First, Middle, Last) *
Current Address: (Street) *
City: *
State: *
Zip *
Day Time Phone: *
Evening Phone:
Email:
What Districts/Buildings are you applying for? *
Required
Previous Work Experience(begin with most recent)Employer, Phone, Position/Duties, Date
Previous Work Experience-Employer, Phone, Position/Duties, Date
Previous Work Experience-Employer, Phone, Position/Duties, Date
Previous Work Experience-Employer, Phone, Position/Duties, Date
Have you ever been placed on probation, discharged or asked to resign from a place of employment? *
Employment References: *
Employment References:
Employment References:
Have you ever been convicted of a Misdemeanor? *
Have you ever been convicted of a Felony? *
Have you ever been placed on diversion or had deferred criminal proceedings involving moral torpitude? (Moral turpitude includes, but is not limited to; theft, murder, rape, swindling, and indency with a minor.) *
Do you presently have pending any violation of law other than minor traffic violations? *
Do you currently have a valid drivers license? *
Education: High School *
Do you have a High School diploma? *
Do you have a GED? *
College Attended:
Number of College hours:
College Degree held:
Specific Skills and Experience (Check all applicable) *
Required
Please indicate (in your own words) why you wish to be considered for this position: *
If offered a position, please indicate when you would be able to begin work: *
Were you referred to us? If so, by whom? (Please include First and Last name of individual and district they currently work in. Also, please include their position in the district.) *
I certify that all the information provided by me in this application is true and complete. I understand that any misstatement, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination. I authorize any of the person or organizations referenced in this application to give you any and all information concerning my previous employment, education or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from liability for any damage that may result from furnishing such information to you. I authorize any background checks by any third party. I authorize you to request, receive, and verify all information given on this application and I release you from all damages that may result from your doing so. I authorize you to conduct a criminal background investigation using all methods necessary to successfully complete such investigation, and I release you from all liability for any damages that may result from your doing so. I further acknowledge that if I am employed by the employer, my employment will be at-will and be terminated with or without cause at any time by me or the employer. (Date and initial) *
In compliance with regulations implementing Title VI, Title IX, Age, Section 504 or Title II of the American with Disabilities Act of 1990, Sumner County Educational Services, Interlocal, District 619 does not engage in discriminatory practices.
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