Application for Support Staff Employment
Date of Application *
MM
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DD
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YYYY
JOB(S) Applied For *
Required
Type of employment *
Are your fingerprints on file with the NYS Education Department? *
Last Name *
Your answer
First Name *
Your answer
Middle Initial
Your answer
Street Address *
Your answer
City/Town *
Your answer
State/Zip code *
Your answer
Phone Number *
Your answer
Have you ever been convicted of a crime, excluding minor traffic offenses?
If yes, please explain in the box below.
Your answer
List any friends or relatives, other than spouse, working for the Southern Cayuga Central School District.
Your answer
Educational Preparation
High School
Please provide name and location
Your answer
Diploma or Degree
College
Please provide name and location
Your answer
Major
Your answer
Minor
Your answer
Diploma or Degree
Business or Trade
Please provide name and location
Your answer
Major
Your answer
Minor
Your answer
Diploma or Degree
Other
Please provide explanation if applicable.
Your answer
Activities, if applicable
Activities in High School, College, and Community:
Your answer
Awards, Honors, and Recognition:
Your answer
Employment Experience
Your Position; Name and Address of Recent Employer; Supervisor's Name; Title; and Telephone Number *
Your answer
Date Employment Began *
MM
/
DD
/
YYYY
Date Employment Ended *
MM
/
DD
/
YYYY
May we contact previous employer? *
Annual Salary
Your answer
Reasons for leaving *
Your answer
Your Position; Name and Address of Recent Employer; Supervisor's Name; Title; and Telephone Number
Your answer
Date Employment Began
MM
/
DD
/
YYYY
Date Employment Ended
MM
/
DD
/
YYYY
May we contact previous employer?
Annual Salary
Your answer
Reasons for leaving
Your answer
Your Position; Name and Address of Recent Employer; Supervisor's Name; Title; and Telephone Number
Your answer
Date Employment Began
MM
/
DD
/
YYYY
Date Employment Ended
MM
/
DD
/
YYYY
May we contact previous employer?
Annual Salary
Your answer
Reasons for leaving
Your answer
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