Teays Valley Local Schools Employment Form – Fill Out and Use This PDF

TEAYS VALLEY LOCAL SCHOOL DISTRICT

385 Circleville Avenue, Ashville, Ohio 43103

Phone: 740-983-5000 Fax: 740-983-4158

CLASSIFIED EMPLOYMENT APPLICATION

What position(s) are you applying for?

Bus Driver

Cafeteria

Custodian

Educational Aide

Secretarial

___Full-Time Employment

Part-Time Employment

Substitute only

PERSONAL INFORMATION:

Last Name

First Name

M.I.

Maiden Name

SSN #

Street Address

City

Zip

Home Phone

Cell Phone

Email Address

EMPLOYMENT HISTORY: (List full-time and/or part-time employment held within the past 7 years beginning with your current employment. Include any military service assignments.)

Company Name:

Phone:

Address:

Your Job Title:

Employed from

to

Reason for Leaving:

Supervisor Name:

May we contact them?

Yes

No

Company Name:

Phone:

Address:

Your Job Title:

Employed from

to

Reason for Leaving:

Supervisor Name:

May we contact them?

Yes

No

Company Name:

Phone:

Address:

Your Job Title:

Employed from

to

Reason for Leaving:

Supervisor Name:

May we contact them?

Yes

No

Include explanation of any gaps in employment:

Are you retired? ___yes ___no Years of experience related to position you are applying for:

Are you a member of STRS, SERS, or a private retirement plan?

Page 1

EDUCATION:

High School		Did you graduate? _____Yes _____No
Location		GED or Equivalent?
College		Degree/Semester Hours:
Location		Course of Study:

TRAINING/SPECIAL SKILLS:

	Computer Skills		ParPro Test Passed			CDL License Received	Military Training
	Fax Machine/Copier		Educational Certificate		Associates Degree		__CPR Training
___Multi-line Phone			Other:

REFERENCES: (Work related not family members)
Name		Phone (	)
Name		Phone (	)
Name		Phone (	)

OTHER:

Are you currently employed? ___yes ___no

If yes, where?

Do you have any physical defects which would prevent you from performing the duties required of a bus driver, custodian, cook,

secretary, etc.: ___yes ___no If yes, please describe.

Have you ever been convicted of any of the following?

a) a felony?	b) a misdemeanor that would be a felony on the second offense?			c) any sex offense?
d) any offense of violence?		e) any theft offense?	f) any drug abuse offense?	yes _____ no _____

If yes, please explain nature and date(s) of occurrence(s):

Proof of citizenship /immigration status will be required upon employment.

CRIMINAL RECORDS CHECK:

I acknowledge being informed that, as a precondition to employment in the position for which I am applying, I must in accordance with House Bill 190, provide an Ohio criminal background check and an FBI criminal background check, conducted by the Bureau of Criminal Identification and Investigation (BCII) if I come under final consideration for employment. I recognize that there will be a charge and unless I pay the fee, I will not be considered for employment.

Signature

Date

CERTIFICATION RELEASE:

I certify the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge. I understand that any false information, failure to list all employment experiences, omissions or misrepresentations of fact called for in this application can result in the rejection of my application, or if employed, termination of my employment with the Teays Valley Local School District. I give the potential employer the right to investigate references and secure additional information about me, if job related. I hereby release from liability the potential employer and its representatives for seeking such information and all other persons, corporations and organizations furnishing such information.

Signature

Date

The Teays Valley Local School District is an equal opportunity employer and does not discriminate on the basis of age, sex, race, religion, color, disability, or national origin in the educational programs and activities it operates.

Revised: 2008

Page 2