The Maranacook Area School District Regional School Unit No. 38

45 Milliard Harrison Drive, Readfield, ME 04355

(207) 685-3336

Application for Student Workers:

RSU No. 38, Maranacook Area School Districtdoesnotdiscriminatein the operationof its educationaland employment policiesand will honorappropriate lawsrelative to discrimination.

Name:

Address:______

Telephone #:_____Email:_____

Experience(s) for past 3 years – jobs, school activities, community involvement, and special hobbies – List most recent first:

Company / School Duties Performed Start /End

Name:
Reason for Leaving:
Name:
Reason for Leaving:
Name:
Reason for Leaving:

References: Please provide three references who are not related to you who are familiar with your work.

Name:Address:Telephone:

BACKGROUND:

Have you ever been terminated from, or asked to leave a previous position? / YES / NO
Describe:
Have you ever been convicted of, or are you presently charged with, reckless driving, operating a motor vehicle while under the influence, or driving to endanger? / YES / NO
Describe:
Have you ever been convicted of, or plead guilty to, or nolo contendere (no contest), to a crime, or are you presently charged with a crime? / YES / NO
Describe:

Failure to describe convictions at the time of application may result in rejection of application or dismissal.

Is any member of your immediate family an employee or school board member within RSU 38? Members of your immediate family shall include: parent, step-parent, child, step-child, spouse, sibling, aunt, uncle, nephew, niece, grandparent, grandchild, in-law, fiancé, significant other, and any other relative who lives in the same household.

Yes ( ) No ( )

If yes, what is the name of that individual(s):

I have applied to be a Student Worker for RSU NO. 38 and authorize them 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 the Maranacook Area School District contacts in connection with my employment application to fully provide the Maranacook Area School District 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 the Maranacook Area School District, 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, administration, other staff, and members of the community. I give my consent to this disclosure.

Signature/Date: ______

Note: All application materials become the property of RSU 38. None will be returned. Applications will be retained for a period of 18 months from the date of receipt. 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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