Classified Position for Which You Are Applyingdate

GARVEYSCHOOL DISTRICT

CLASSIFIED EMPLOYMENT APPLICATION

Classified Position for Which You Are ApplyingDate

P L E A S E P R I N T C L E A R L Y O R T Y P E

1. NAME 2.

FirstLast Initial Social Security Number

List other names used in employment

3. ADDRESS A) ( )

No. & Street Apt. No. (Area Code) Home Phone Number

B) ( )

CityState Zip Code (Area Code) Contact Phone Number

Email address: C) ( )

(Area Code) Cellular/Pager Number

4. Date you would be available for work:

Applicants, if employed, will be required to be fingerprinted for a criminal records check and required to submit proof of their legal right to work in the U.S.

The law provides equal employment opportunity regardless of race, religion, sex, age, physical handicap or national origin. Employment acceptance or rejection will be based on job related criteria.

If a transcript, credential, permit or a license is required for the position, it must also be attached to this application in order for the application to be considered complete.

The legibility, completeness and grammatical correctness of the application will be included in the evaluation of the candidate’s qualifications for the position.

ALL QUESTIONS ON THIS APPLICATION MUST BE ANSWERED. AN INCOMPLETE APPLICATION MAY RESULT IN DISQUALIFICATION OF THE APPLICANT FROM FURTHER CONSIDERATION.

NOTE:THE COMPLETENESS AND RECEIPT OF ALL MATERIALS ARE THE CANDIDATE’S RESPONSIBILITY.

5.EDUCATION

Circle Highest School Grade Completed: 1 2 3 4 5 6 7 8 9 10 11 12 G.E.D. College 1yr. 2yrs. 3yrs. 4yrs.

Name of School / City and State / Number of Years
Attended / Major Course
Of Study / Units / Degree or Certification

(Attach copies of above listed college transcripts, if applicable.)

6.SPECIAL SKILLS (List other formal training program which may be related to the type of employment you are seeking.)

7.List any professional or technical licenses or certification which may be related to the type of employment you are seeking.)

8.Are you or have you ever been a member of the Public Employee’s Retirement System (PERS)?Yes No

Are you or have you ever been a member of the State Teacher’s Retirement System (STRS)?Yes No

9.Use of languages other than English:

SpeakReadWrite

State LanguageDegree of Fluency

SpeakReadWrite

State LanguageDegree of Fluency

10.Have you ever been convicted for anything other than a minor traffic violation?Yes No

If yes, please list all convictions and dates below.

(This information will not necessarily disqualify you for this position; however, failure to admit is cause for disqualification.)

11.Do you have relatives presently working for the GarveySchool District?Yes No

If yes, please indicate below:

Name / Position / Relationship to you

12.Do you have a valid California Driver’s License? (applicable only if job related)Yes No

If no, can you acquire a California Driver’s License if needed for employment? Yes No

California Driver’s License Number: Expiration Date:

13.Have you ever been employed by the GarveySchool District?Yes No

14.EMPLOYMENT HISTORY: List your work record below. Begin with your present job and list in reverse order. Include volunteer, or other special experience which applies to the position you are seeking.

May we contact your present and previous employers?YesNo

Job Title / From: Month/Year / To: Month/Year / Name of Employer or Company / Phone Number
Full Time/Part Time / Last Salary / Hourly:
Weekly:
Monthly: / Address of Employer or Company / Type of Business or
Organization
Reason for Leaving / Your Supervisor’s Name and Job Title

Describe your duties fully:

TESTING INFORMATION

ANSWER EACH QUESTION.

AN INCOMPLETE APPLICATION MAY RESULT IN DISQUALIFICATION.

IF UNCERTAIN ON DATE(S), INDICATE APPROXIMATE MONTH AND YEAR TEST WAS TAKEN. Do not leave any area blank:

A.WRITTEN TEST

Have you previously taken the specificWritten Test(s) required for this position in the GarveySchool District? Yes______No_____

IF YES, did you pass the written test for this position?YesNo

IF YES, DATE TAKEN:MonthDayYear

PERFORMANCE TEST

Have you taken the specificPerformance Test(s) required for this position in the GarveySchool District?

(i.e., typing, computer, shorthand, maintenance, custodial, stock clerk/driver, etc.)

YesNoN/A

IF YES, did you pass the performance test(s) for this position? YesNo

IF YES, DATE TAKEN:MonthDayYear

I certify that all information and/or statements are true to the best of my knowledge. I understand that false information and/or statements shall be sufficient cause for removal from consideration, as an applicant, or dismissal as an employee. I hereby release from all liability any persons or organizations furnishing such information. I agree to conform to district regulations concerning a tuberculosis examination and I understand that I will be required by law to be fingerprinted.

Signature:Date:

How did you hear of this opening?

Return Application to: GARVEYSCHOOL DISTRICT, Human Resources Department

2730 N. Del Mar Avenue, Rosemead, CA 91770

Telephone: (626) 307-3486JOB HOTLINE: (626) 307-3430, Ext. 8990FAX: (626) 307-3492

Business Hours: 8:00 a.m. – 5:00 p.m. (Monday – Friday)

The Governing Board prohibits unlawful discrimination against and/or harassment of district employees and job applicants on the basis of actual or perceived race, color, national origin, ancestry, religious creed, age, marital status, pregnancy, physical or mental disability, medical condition, veteran status, gender or sexual orientation, at any district site and/or activity. (Board Policy 4030)

AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

(Revised 6/09)