South Henry School Corporation

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  •  (Printable Non-Certified Employment Application)

     

    SOUTH HENRY SCHOOL CORPORATION

     

    NON-TEACHING APPLICATION

     

     

    APPLYING FOR (PLEASE CHECK):         BUS AIDE:           _____          BUS DRIVER:       _____

                                                                     CUSTODIAN:                _____          MAINTENANCE    _____

                                                                     INSTR ASST/TITLE 1 AIDE (TEACHER AIDE)      __________

                                                                     BUILDING SECRETARY:                            ___________

                                                                     BUILDING TREASURER:                            ___________       

                                                                     COACH: (LIST DESIRED SPORT) ___________________________

     

    DATE:         __________________________

     

    APPLICANT INFORMATION:         

     

    NAME:        ________________________________________________________

                                                     

    ADDRESS:           ________________________________________________________

                                                                         

                               ________________________________________________________

     

    TELEPHONE NUMBER:  ______________________________________________

     

    Make any statement here that you consider pertinent to your application stating why you think you can qualify for this type of work: _________________________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________

     

    Please list at least 2 persons who know you personally:

                        Name                                                                                          Phone Number

     

    1. _____________________________________________________________________________________

     

    1. _____________________________________________________________________________________

     

    Graduated From: _____________________________ Year of Graduation ___________

                                            High School

     

    List of Education above High School:

     _______________________________________________________________________________________________________

     _______________________________________________________________________________________________________

     _______________________________________________________________________________________________________

     _______________________________________________________________________________________________________

     

    List all your work experiences:

               Place of Employment                    Position               Length of Employment

     

                                            ________                                   _________________________

     

                                            ________                                   _________________________

     

                                            ________                                   _________________________

     

                                            ________                                   _________________________

     

                                            ________                                   _________________________

     

     

    References:

                        Name                              Address                                  Phone Number

     

    1. ________________________________________________________________________________

     

    1. ________________________________________________________________________________

     

    1. ________________________________________________________________________________

     

    1. ________________________________________________________________________________

     

     

    Return Application to:

    Office of the Superintendent:

    South Henry School Corporation

    6972 So State Road 103

    Straughn, IN  47387

    Phone:  765-987-7882

    Fax:      765-987-7589

     

    For Questions, Call or Email:

    Lisa Butler

    Corporation Secretary

    765-987-7882 ext. 151

    lbutler@shenry.k12.in.us

               

    Request for Background Information:

    Employment in the South Henry School Corporation involves working with our student population. We ask that you complete the questions below to help us evaluate your suitability to work with these students. All applicants for employment are expected to provide us with this information. Any misrepresentation or omission of fact may be grounds for disqualification from further consideration, or for termination from employment regardless of when the misrepresentation or omission is discovered.

    The conviction of a crime, or any affirmative answer provided by you is not an automatic bar to employment. Employment evaluators will consider the nature of any conviction or alleged conduct underlying the affirmative response, the date of the alleged conduct in question, your intervening conduct and the relationship between the offense and the position for which you are applying.

     

    1. If you are now working, is your conduct as an employee, or the quality of your work, the focus of any investigation by your current employer?

              Yes_____ No_____

    1. Have you ever resigned from a job after being disciplined by your employer, or after being offered the opportunity to resign rather than be terminated?

              Yes_____ No_____

    1. Have you ever been investigated for, charged with, or plead guilty or “no contest” to any crime involving the sexual abuse of any person or indecency with a minor?

              Yes_____ No_____

    1. Have you ever been charged with a crime other than a minor traffic offense, where the court has deferred further proceedings without entering a finding of guilt and placed you on probation, public service, or education program?                                                                                           Y

               Yes____ No _____

    ** (If yes is answered to any of the above questions, explain the circumstances on a separate sheet and attach it to this application.)**

     

     

    Authorization and Release:

    I authorize the South Henry School Corporation to check my employment history, including with limitation, reference checks, and to seek the release of investigatory information. I expressly waive in connection with any request for, or provision of such information, any claims or causes of action including without limitation, defamation, infliction of emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the school corporation, its officials, employees, trustees or agents, or against any provider of such information.

     

    I have read this authorization and release of all claims and I agree to the terms set forth.

     

    Please Print Your Name: ___________________________________________________

     

     

    Signature: ___________________________________            Date: ____________________

     

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