1000 South Eighth Street

L E B A N O N S C H O O L D I S T R I C T

Lebanon, Pennsylvania 17042

APPLICATION FOR EMPLOYMENT

(Support Staff)

Lebanon School District is an equal opportunity institution and will not discriminate on the basis of race, color, national origin, sex, and handicap in its activities, programs or employment practices as required by Title VI, Title IX and Section 504.

El Distrito Escolar de Lebanon es una institución de educación con igualdad de oportunidades y no discriminará en base a raza, origen nacional, sexo o incapacidad en sus actividades, programas o practicas de empleo como lo requiere Título VI, Título IX y la Sección 504.

POSITION APPLYING FOR:

SECRETARIAL/CLERICAL

MAINTENANCE

CUSTODIAL

SECURITY

PERONAL CARE ASSISTANT

OTHER (DESCRIBE)

Paraprofessional Positions:

(**No Child Left Behind qualified=Associate’s Degree or 48 college credits)

PARAPROFESSIONAL**

Last Name: First name: Middle Initial:

Street Address: City, State, Zip:

Home Phone Number: Cell Phone Number:

Email Address:

Social Security Number: Salary Expected: $

Are you a licensed motor vehicle operator? Yes No

Have you ever been convicted of a misdemeanor or felony? Yes No

If so, please explain:

Do you have a legal right to live and work in the Unites States? Yes No

Were you ever in our employ? Yes No Employed from to

Position and School:

Reason for Leaving the Lebanon School District:

Names of relatives in our employ:

Names of friends in our employ:

Referred to the Lebanon School District by whom:

Summary of Education:

Name of School / Location / Dates Attended / Graduated or Left / Degree
Grade School
High School
College
Business/Technical School

Employment History

Reverse Chronological (Most recent employment first) Account for every year. Explain lapse in employment

Company
Name & Address / Kind of Industry / From / To / Salary / Position / Reason for Leaving

Other Formal Training (List nature, institution and dates)

REFERENCES

Give the name of three persons who are acquainted with your abilities, habits and character, and have consented to furnish a recommendation.

Reference #1
Name:
Street Address:
City, State, Zip:
Telephone Number:
Reference #2
Name:
Street Address:
City, State, Zip:
Telephone Number:
Reference #3
Name:
Street Address:
City, State, Zip:
Telephone Number:

State your reasons for desiring to work for the Lebanon School District:

Are you able to perform the essential functions of the position(s) you are applying for with or without reasonable accommodations? Yes No

Upon the offer and acceptance of employment with the Lebanon School District, I agree that I will obtain a physical examination, complete Act 34, 151 and 114 clearances. I understand that my employment may be terminated in the case of a criminal record and/or child abuse finding. I also agree that I must receive negative Tuberculosis test prior to my employment with the Lebanon School District.

I certify that the above facts are true to the best of my knowledge and understand that misrepresentations are sufficient to disqualify me from employment and justification for dismissal at a later date.

Signature of applicant: Date:

(Typed name is acceptable)

This Application will be considered active for Six Months