NDSEC Extended School Year 2021 Employment Application
First Name: *
Last Name: *
Street Address: *
City: *
State: *
Zip Code: *
Phone Number: *
Email Address: *
Emergency Contact Person & Relationship *
Emergency Contact Phone Number: *
Special Education License for which you are approved (check all that apply): *
Present Position (check all that apply) *
Are you CPI Trained & Certified? *
Which district or cooperative do you currently work for? *
What position are you applying for? (check all that apply) *
Parapros Only: Are you working as a 1:1 assistant?
Clear selection
If you answered "Yes" to the previous question, who is the student you are 1:1 for?
List References: (Name, Relationship, Phone Number) *
Have you worked in NDSEC ESY programs in the past? *
If you answered "Yes" to the previous question please provide the dates you have worked.
Tee Shirt Size: *
If you are not hired for a full time position - are you willing to be a substitute? *
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