•  (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

     

    An Equal Opportunity Employer

    South Henry School Corporation                                                                                                                                                                                                                                               Page 2

     

    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_____ 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?

    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: ____________________

     

     

     

     

    An Equal Opportunity Employer

    South Henry School Corporation                                                                                                                                                                                                                                               Page 3