Rockland BOCES Registered Nurse, TA/Aide and Transportation Employee Application
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Are you able to attend our Job Fair on November 12, 2025 between the hours of 4-8pm?  
Rockland BOCES
65 Parrott Rd., West Nyack, NY 10994
Building 10
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Last Name *
First Name *
Email Address *
Home Address *
Phone Number *
Position Applying For: *
Type of Employment *
Educational Preparation *
Required
Current Certifications
Most Recent Employment Information (Position, Employer and Address)
Were you ever appointed to tenure in a public school district in New York State? 
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Were you ever appointed to tenure in a public school district in New York State? If you answered Yes to the question above please list:    
Area of Tenure  
Date Granted  
District  
Other Work Experience  (Position, Employer and Address)
Other Work Experience  (Position, Employer and Address)
Additional Languages Spoken
Veteran of U.S. Military *
Have you ever been fingerprinted for the purpose of employment? *
If you answered Yes to the question above please list:  
Where 
When 
Are you legally eligible for employment in this country? *
Have you ever forfeited bail or bond following your appearance as a defendant in a criminal court action? *
Have you ever received an unsatisfactory rating in conjunction with any pedagogical employment? *
Have you ever been disqualified for employment for any civil service position? *
Have you ever been discharged or required to resign from any position? *
Have you ever been found guilty and /or have you ever pleaded guilty to disciplinary charges brought against you under Section 3020-a of the Education Law or Section 75 of the Civil Service Law? *
Have you ever resigned as an alternative to facing charges or dismissal? *
Have you ever had a license or certificate denied or terminated because of unsatisfactory teaching, fingerprints, or medical record? *
Have you ever had any professional certificate or license denied, revoked, or suspended by any government agency as a result of your record? *
Has a family court or any other court ever rendered a finding indicating that you have abused or neglected a child? *
If you answered Yes to the question above please list:
Date and Nature of the finding. 
Name of the Court.
Name of the Judge. 
Reference ( Name, Position, Address, Phone Number) *
Reference ( Name, Position, Address, Phone Number)
 *
Reference ( Name, Position, Address, Phone Number)
I certify that all statements made by me on this application are true and complete to the best of my knowledge. I understand that any false or misleading statements will be considered justification for disqualification of my application or termination of employment. I authorize an investigation of all statements herein and further authorize all cited references to give you any and all information they may have, and release all parties from all liability for any damage that may result from furnishing same to you. I authorize any participating school district for which I have completed an employment application to check my references, to obtain information from my former employers and educational institutions, to take other action to investigate any information provided in my employment application, and to obtain information relevant to evaluating my qualifications and fitness for a position. I authorize any school district to which this application is submitted to obtain information about my criminal record and authorize all government agencies to provide information about my criminal record to the school district. I understand that any omissions on this application may prevent my application from being evaluated or referred to a school district and that any misrepresentation, falsification or omission on this application or on other documents submitted to the school district will be sufficient cause for this application not to be considered by the school district, not to be referred to a school district, or for discharge if I have been employed. Please type your name to acknowlegde your application.   *
The BOCES and participating school districts do not discriminate on the basis of sex, race, color, creed, national origin, religion, age, disability, sexual orientation, marital status, veteran status, or genetic predisposition for carrier status in their recruitment, employment, admissions practices, vocational opportunities or access to and treatment in programs or activities in accordance with Title IX, Section 504 of the Rehabilitation Act of 1973, Title VI and Title VII of the Americans with Disabilities Act. If you believe you have been subject to discrimination, please contact the EEO officer of the respective school district. If offered employment by this school district, I certify that I have not already accepted an offer of employment from another school district. I am committed to fulfilling the obligations of this employment offer.   Please type your name to acknowledge your application.
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