Pendleton County Schools

PENDLETON COUNTY SCHOOLS

2525 Hwy. 27 North, Falmouth, KY 41040

Phone (859) 654-6911 Fax (859) 654-6143

Website:

SUBSTITUTE - CLASSIFIED APPLICATION

Date ______

Name ______

Last First Middle

Have you graduated from a High School or GED program? Yes ____ No _____

If yes, you must attach a copy of your diploma/certificate to be considered for employment.

Substitute Positions Desired (check all that applies):

¤ Bus Driver ¤ Instructional Assistant

¤ Bus Monitor ¤ Nurse

¤ Custodian ¤ Other: ______

¤ Food Service

When would you be available to begin work? ______

List schools you are interested in working at (check all that apply):

¤All Schools

¤Pendleton County High School

¤Phillip Sharpe Middle School

¤Northern Elementary School

¤Southern Elementary School

¤ Other Facility ______

List days of the week you are available to work: ______

Referral Source:

Advertisement _____ Government Employment Agency _____

Walk-In _____ Private Employment Agency _____

Relative _____ Pendleton County Web-Site _____

Employee _____ Name of Source (if applicable) ______

FOR PERSONNEL USE ONLY:

TABE PASSED/SCORES - READ______MATH______PARAEDUCATOR PASS/SCORES ______

DIPLOMA/GED ______

INSTRUCTIONS AND INFORMATION

Applicant must file the following documents with the Human Resource office at the Pendleton Board of Education, 2525 Highway 27 North, Falmouth, KY 41040 before you can be considered for employment.

1.  Completed and signed application.

2.  Copy of high school diploma, G.E.D., or documentation of enrollment and satisfactory progress in a G.E.D. program. (According to the new state regulations, employees initially hired after July 13, 1990 shall hold a high school diploma or GED certificate, or be enrolled in a GED program and be progressing satisfactorily as defined by administration regulations adopted by the State Board for Adult Vocational Education and Vocational Rehabilitation.)

3.  An applicant applying for an Instructional Assistant position must have taken and passed the TABE and PARAEDUCATOR TEST(S) prior to the position deadline. (Tests are given at the Adult Learning Center. Call 859-654-3325, extension 2600 or 2601 for an appointment.) The applicant is qualified if 48 college credit hours has been completed with a GPA of 2.25 or above. An original transcript must be attached to the completed application.

4.  If applying for a driving position, a Driving Records Report for the past five (5) years. Contact the Human Resource department at the Board of Education when submitting employment application to fill out the request form.

Follow directions carefully. Specific information is necessary to adequately evaluate an applicant’s qualifications. All items must be completed. Write NA if the item is not applicable.

After your application credentials are received, you MAY be selected to proceed in the interview process. The Pendleton County Board of Education is in no way obligated by the filing of this application and its acceptance does not indicate that there are open positions.

All applications are kept on file three (3) years unless otherwise notified.

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PERSONAL DATE:

PLEASE PRINT

Last Name First Middle

Street Address Home Phone Cell Phone

City State Zip

Email address Business Phone Number

May we contact you at work? ___Yes ___No

In the past have you ever applied for employment with us? c No c Yes

If yes: Month and Year______Location/Position______

Social Security Number

EDUCATIONAL BACKGROUND

Name, Address, City, State, Zip / COURSE OF STUDY / # OF YEARS
COMPLETED / DID YOU GRADUATE? / TYPE OF DEGREE OR DIPLOMA
High School / ___ Yes___No Year Graduated
______
College / ____Yes
____ No
Other / ____Yes
____ No

MILITARY (complete this section if you served in the U.S. Armed Forces)

Describe your duties and any special training / Branch of Service
Period of Active Duty (Month & Year)
From ______to ______
Date of Discharge

PREVIOUS EMPLOYMENT INFORMATION: (list in order of most recent experience)

Company Name / Telephone
Address / Employed (Month & Year)
From To
Name of Supervisor
c Do not contact this employer / Weekly Pay
Beginning Ending
List your job title and describe your work / Reason for Leaving
Company Name / Telephone
Address / Employed (Month & Year)
From To
Name of Supervisor
c Do not contact this employer / Weekly Pay
Beginning Ending
List your job title and describe your work / Reason for Leaving
Company Name / Telephone
Address / Employed (Month & Year)
From To
Name of Supervisor
c Do not contact this employer / Weekly Pay
Beginning Ending
List your job title and describe your work / Reason for Leaving

MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS

LIST PROFESSIONAL, TRADE BUSINESS, OR CIVIC ASSOCIATIONS AND ANYOFFICES HELD. (EXCLUDE MEMBERSHIPS THAT WOULD REVEAL SEX, RACE, RELIGION, NATIONAL ORIGIN, AGE, COLOR, DISABILITY OR OTHER PROTECTED STATUS.)

SPECIAL SKILLS

List specific skills and/or any machines or equipment you can operate. Include typing speed if applicable. Attach additional sheets if necessary.

1 5

2 6

3 7

4 8

List computer programs you are familiar with (check all that apply). Rate your skills by circling 1-5 with (1) being poor to (5) being extremely familiar.

¤Word – 1 2 3 4 5 ¤Excel – 1 2 3 4 5 ¤Power Point – 1 2 3 4 5

¤Access – 1 2 3 4 5 ¤Email – 1 2 3 4 5 ¤Internet – 1 2 3 4 5

Other: 1) ______3) ______

2) ______4) ______

GENERAL INFORMATION

Will you work overtime if asked? ¤Yes ¤ No

Are you legally eligible for employment in the United States? ¤Yes ¤ No

Have you ever been suspended, asked to resign, or terminated from an employer?

¤Yes ¤ No

If yes, please explain. ______

______

Have you ever been convicted of violation of any law, regulation or ordinance in the last seven years? ¤Yes ¤ No

If yes, please explain. (Such conviction may be relevant if job related, but does not bar you from employment.)

______

Have you ever been bonded? ¤Yes ¤ No

If yes, with what employer(s)? ______

Are you related to a Board member or the Superintendent of Pendleton County Schools?

¤ Yes, related to: ______Relationship: ______

¤No

REFERENCES

Give full name and complete address of each reference. In naming references, please include all managers/supervisors at the last two employing organizations who evaluated or supervised your performance. The judgment of a nonprofessional person in reference is usually valuable only from the standpoint of general character.

Manager/Supervisor Name / School District/Firm Name / Address,
City, State, Zip / Position Title / Phone #

The Pendleton County Board of Education is an Equal Opportunity Employer. It does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in the employment of services.

No question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local state or federal law. Selection of candidates for positions will be upon the basis of demonstrated capability, competence, and appropriate experience.

All Pendleton County Schools’ programs are operated in compliance with TITLE IX regulations regarding sex discrimination and Section 504 regarding disabled persons.

Any and/or all questions or issues related to discrimination policies, procedures or practices are to be directed to the Human Resources Office, Pendleton County Schools, 2525 Hwy 27 N., Falmouth, KY 41040 (859) 654-6911.

REQUIRED UPON EMPLOYMENT:

·  For this type of employment, State law requires a State Criminal history background check as a condition of employment. This will be done at the Pendleton County Board of Education office. A $20.00 fee will be charged at the time of fingerprinting.

·  A completed medical exam / TB assessment / drug screen at St Elizabeth Business Health Center. Information given at Orientation. (Cost is employee’s responsibility.) Call Fay at 859-654-6911

Please carefully read the following, sign and date below.

I hereby affirm that the information given by me in this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission will be sufficient cause for cancellation of this application or discharge if I have been employed.

I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand that the District is required by state law to obtain criminal history record information on applicants as a condition of employment. I hereby give the District permission to make inquiries from any law enforcement agency.

It is agreed by and between the Pendleton County Schools and employee that an employee is an “at-will” employee and that the Superintendent may terminate the employment contract at any time.

Signature of Applicant ______

Date of Signature ______

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