SOUTH HENRY SCHOOL CORPORATION
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) ___________________________
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
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
Name Address Phone Number
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
An Equal Opportunity Employer
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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.
- 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, or 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?
** (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: ____________________
An Equal Opportunity Employer
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