EMPLOYMENT APPLICATION NON-CERTIFIED PERSONNEL
This application constitutes part of the examination process. It must be completed fully and accurately even if a resume or other supporting materials are attached. Applications may be rejected or receive less consideration if answers are incomplete, vague or evasive. All statements are subject to investigation. Statements of fact found to be false, exaggerated or misleading will result in your disqualification.
Position Applied For: ______Availability: ______
Applicant’s Name: ______First Middle Last Other Names
Worked Under
Address: ______Street
______City State Zip Code
Telephone Number: ______(Home)
______(Cell)
______(Work)
Education
Diploma
Name of Institution Relevant Course Work or Degree
High School: ______
College: ______
______
Other Educational/ ______
Computer
Experience: ______
______
“AN EQUAL OPPORTUNITY EMPLOYER”
EMPLOYMENT HISTORY
Current/Most Recent Employer:______From:______To:______
Address:______Phone:______
Name/Title of Supervisor______May we contact:______/______
Yes No
Your Title:______Salary:______
Duties:______
Reason for Leaving______
Name of Employer:______From:______To:______
Address:______Phone:______
Name/Title of Supervisor:______
Your Title:______Salary:______
Duties:______
Reason for Leaving:______
Name of Employer:______From:______To:______
Address:______Phone:______
Name/Title of Supervisor:______
Your Title:______Salary:______
Duties:______
Reason for Leaving:______
Name of Employer:______From:______To:______
Address:______Phone:______
Name/Title of Supervisor:______
Your Title:______Salary:______
Duties:______
Reason for Leaving:______
REFERENCES: List three (3) individuals (excluding relatives and previous employers).
Name Address Daytime Phone Number
1. ______
2. ______
3. ______
SPECIALIZED TRAINING AND SKILLS: List any special qualifications or experience not covered elsewhere in this application which you feel may qualify you for the position for which you are applying (include seminars, areas of research, special awards, professional memberships and licenses).
______
Please complete, if applicable to the job for which you are applying:
______Driver’s License, Class ______
Operate:
______Switchboard ______Calculator ______Computer Terminal ______Word Processor
Shorthand at: ______w.p.m. Typing at: ______w.p.m. ______Lotus 1-2-3 or other
spreadsheet programs
List other office equipment:______
______
I certify that there are no misrepresentations, omissions or falsifications in the foregoing statements and answers, and that the responses given are true, complete and accurate to the best of my knowledge and are made in good faith. I understand that any misrepresentations, omissions or falsification of information by me on this application or in connection with any aspect of the interview and/or selection process is grounds for rejection of my application and/or immediate discharge.
I authorize all of the educators, employers and personal references listed to release to the Enfield Board of Education information (including documents and/or other records) regarding my education, employment history or any other matter related to my application for employment with the Enfield Board of Education.
______
Signature Date
“AN EQUAL OPPORTUNITY EMPLOYER”
Public Act 93-328 – An Act Concerning Applicants For School Employee Position
Each local or regional board of education shall (1) require each applicant for a position in a public school to state whether such person has ever been convicted of a crime or whether criminal charges are pending against such person at the time of application, and (2) require each person hired by the board after July 1, 1994, to submit to state and national criminal history records check.
REQUIRED STATEMENT FROM CANDIDATE
Your application of employment will not be processed without this addendum completed, signed and dated. Please check all that apply.
Check appropriate statements below, sign and date.
1.______At the time of submitting this application, I have been convicted of a crime.
2. ______At the time of submitting this application, I have criminal charges pending against me.
3. ______At the time of submitting this application, I have not been convicted of a crime.
4. ______At the time of submitting this application, I do not have criminal charges pending
against me.
If line 1 or 2 above have been checked, please provide a statement below explaining the crime or charges. You may make appropriate attachments.
______
______
______
______
______
Signature Date