SCHOOL ADMINISTRATION DISTRICT #4

25 CAMPUS DRIVE –DROP #2

GUILFORD, MAINE 04443

APPLICATION FOR NON-TEACHING POSITION

The School Administrative District does not discriminate in the operation of its educational and employment policies and will honor all appropriate laws relative to discrimination.

Date____________________________________ Position(s) applying for:

Name___________________________________ __________________________________________

(Bus Driver, Custodian, Secretary, Ed. Tech, Food Service, etc.)

Social Security No. ______-_______-________

When will you be available?_______________ __________________________________________

Permanent Address__________________________________________ Phone___________________

Temporary Address__________________________________________ Phone___________________

EDUCATION: Starting with high school, list any schools or colleges you may have attended. No. of Yrs.

School Attended Address Attended Graduated/Degree

_______________________________ ____________________ _________ _______________

SPECIAL SKILLS:

Do you hold a valid drivers license?______ State:___________ Endorsement:________________

To be completed by clerical applicants: Typing: _____Yes _____No WPM___________

Shorthand: _____Yes _____No WPM___________

What office machines are you familiar with?____________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What other special skills do you have or licenses do you hold that may be relevant to this position?______

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EXPERIENCE: Please list all previous employment starting with the most recent job held. Use the back of the page if necessary. Please account for any gaps in employment during the past ten years on the back of page.

From To Position Duties Employer

(month/year)

______to_____ _______________________ _________________ ________________________

BACKGROUND:

Have you ever been disciplined, discharged, or asked to resign from a prior position? Yes____ No____

Have you ever resigned from a prior position after a complaint had been received

against you or your conduct was under investigation or review? Yes____No____

Has your contract in a prior position ever been non-renewed? Yes____No____

Have you ever not been nominated for re-employment in a prior position or ever had

your nomination for re-employment not be approved? Yes____No____

Have you ever been charged with or investigated for sexual abuse or harassment of

another person? Yes____No____

Have you ever been convicted of a crime (other than a minor traffic offense)? Yes____No____

Have you ever entered a plea of guilty or “no contest” (nolo contendere) to any crime

(other than a minor traffic offense)? Yes____No____

Have you ever had a professional license or certificate suspended or revoked in any

state, or have you ever voluntarily surrounded, temporarily or permanently,

professional license or certificate in any state? Yes____No____

Has any court ever deferred, filed or dismissed proceedings without a finding of guilty

and required that you pay a fine, penalty or court costs and/or imposed a requirement

as to your behavior or conduct for a period of time in connection with any crime

(other than a minor traffic offense)? Yes____No____

For BUS DRIVER applicants only: Have you ever been charged with a traffic offense or

pleaded guilty or “no contest” (nolo contendere) to a traffic offense? Yes____No____

If you have answered YES to any of the previous questions, provide full details below including, with respect to court actions, the date, offense in questions, and the address of the court involved. Use an additional sheet if necessary. Conviction or other disposition of a crime is not necessarily an automatic bar to employment.

____________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________

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REFERENCES: List three, two of who are most recent supervisors, who can comment on your ability and whom we may contact.

Name Position Address Telephone

SIGNATURE:

My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize those persons, agencies or entities that SAD #4 contacts in connection with my employment application to fully provide SAD #4 any information on the matters set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against SAD#4 its agents and officials or against any provider of such information.

I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include board members, administrators, other staff, and members of the community. I give my consent to this disclosure.

___________________________________

Signature/Date

APPLICATION FOR NON-TEACHING POSITION CHECK LIST: The completed employment application cannot be evaluated unless all of the following materials have been provided:

________ Application form fully completed

________ Gaps in employment during the past ten years explained

________ YES to any of the questions in the Background section explained

________ Application signed

NOTE: ALL APPLICATION MATERIALS BECOME THE PROPERTY OF SAD #4. NONE WILL BE RETURNED. PROVIDING ANY FALSE OR MISLEADING INFORMATION ON THIS APPLICATION OR IN THE APPLICATION OR EMPLOYMENT SCREENING PROCESS SHALL BE FULLY SUFFICIENT GROUNDS TO REFUSE TO EMPLOY THE APPLICANT OR, IF THE APPLICANT HAS BEEN EMPLOYED, TO IMMEDIATELY DISMISS THE APPLICANT/EMPLOYEE.

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