SOUTH HENRY SCHOOL CORPORATION
6972 So. St. Rd. 103
Straughn, IN 47387
1. Name in full (Ms.)
2. Present address_____________________________________ Phone ( ) _____________
_____________________________________ Zip Code______________
3. Permanent address __________________________________ Phone ( ) ____________
__________________________________ Zip Code______________
4. For what position (grade or subjects) do you wish to apply?_________________________
5. Organizations to which you belong? _____________________________________________
7. When could you begin work? __________ Are you under contract for next year? ___________
8. Underscore any of the following which you are able to direct successfully: Debates, School
Plays, Oratorical Contests, Orchestra, Band Clubs, Football, Basketball, Baseball, Track,
Tennis, Playground Activities, Wrestling, or Golf. (Add any others)
9. Please give in detail your Educational and Professional Training
10. References: List five references, including superintendents and principals under whom you
have taught. If references are listed in college credentials, it is not necessary to list them.
Name Address Telephone Official Position
11. Give complete information regarding your TEACHING EXPERIENCE
Name of School Location Grade or Subject Date Critic Teacher
12. TEACHING EXPERIENCE UNDER CONTRACT:
13. Please give a brief reason for wanting to be considered for a position with the SOUTH
HENRY SCHOOL CORPORATION.
14. MILITARY EXPERIENCE
AN EQUAL OPPORTUNITY EMPLOYER
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_______
2. Have you ever resigned from a job after being disciplined by your employer, of after being offered the opportunity to resign rather than be terminated? Yes______ No ______
3. 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______
4. 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? 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.)
I authorize the South Henry School Corporation to check my employment history, including without limitation, reference checks, and to seek the release of investigator information, including an “expanded criminal history” possessed by any private or public employer or any local, state, or federal agency concerning matters described herein. I will cooperate to the extent necessary to obtain the release of this 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