ParaprofessionalOffice of Special Education

Application ForHartfordSchool District

Employment64 Hebard Street

White River Jct., VT05001

We consider applicants for all positions without regard to race, color, religion, national origin, place of birth, sex, sexual orientation, age, the presence of a non-job-related medical condition or disability, or any other legally protected status.

(PLEASE PRINT)

Date of Application ______

Paraprofessional Position(s) Applied For: ______

Age Group Preferred:_____ Elementary_____ Middle School_____High School

Building Preference: ______

Positions Preferred:_____ Special Education_____ Classroom_____ Library

_____ Clerical_____ Math_____ Reading

List Clerical Skills: ______

Name ______

LASTFIRSTMIDDLE

Address ______

NUMBERSTREETCITYSTATEZIP

Telephone (______)______

  1. Have you filed an application here before? ___ Yes___ NoIf yes, give date ______
  1. Have you been employed here before?___ Yes___ NoIf yes, give date ______
  2. Are you employed now? ___ Yes___ No
  3. May we contact your present employer___ Yes___ No
  4. Are you prevented from lawfully becoming employed

in this country because of Visa or Immigration Status?___ Yes___ No

(Proof of citizenship or immigration status will be required upon employment)

  1. On what date would you be available for work? ______
  2. Are you available to work ___ Full-Time? ___ Part-Time? ___ Temporary?
  3. Can you travel if a job requires it?___ Yes___ No
  1. Do you have a commercial bus drivers license (CDL)?___ Yes___ No
  1. Have you ever been convicted of a: ___ misdemeanor? ___ felony? ___ motor vehicle violation?

If so, please explain, including the state in which this took place. ______

  1. Have you ever been charged with any type of child abuse or child sexual abuse? ___ Yes___ No

If so, what was the disposition of said charges? ______

If so, in what state did said charges take place? ______

  1. Are you willing to obtain a CDL, at the district’s expense, and drive a school bus? ___ Yes___ No

AN EQUAL OPPORTUNITY EMPLOYER

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Employment Experience

Start with your present or last job and list all employers for the past five (5) years. Include military service assignments and volunteer activities. You may exclude organization names, which indicate race, color, religion, gender, national origin, disability or other protected status.

1.

Employer / Telephone
( ) / Dates Employed
From To / Work Performed
Address
Hourly Rate/Salary
Job Title / Starting To
Supervisor
Reason for Leaving

2.

Employer / Telephone
( ) / Dates Employed
From To / Work Performed
Address
Hourly Rate/Salary
Job Title / Starting To
Supervisor
Reason for Leaving

3.

Employer / Telephone
( ) / Dates Employed
From To / Work Performed
Address
Hourly Rate/Salary
Job Title / Starting To
Supervisor
Reason for Leaving

4.

Employer / Telephone
( ) / Dates Employed
From To / Work Performed
Address
Hourly Rate/Salary
Job Title / Starting To
Supervisor
Reason for Leaving

5.

Employer / Telephone
( ) / Dates Employed
From To / Work Performed
Address
Hourly Rate/Salary
Job Title / Starting To
Supervisor
Reason for Leaving

(If you need additional space, please continue on the back of this application.)

Special Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experience. ______

______

______

Education

Elementary / High School / College/University / Graduate/Professional
School Name
Years Completed/Degree / 4 5 6 7 8 / 9 10 11 12 121212 / 1 2 3 4 / 1 2 3 4
Diploma/Degree
Describe Course of Study:
Describe Specialized
Training, Apprenticeship, Skills and Extra-Curricular Activities

Honors Received: State any additional information you feel may be helpful to us in considering your application.

______

______

______

References

Professional: / Name / Address / Phone Number
Personal:

Applicant’s Statement

I certify that answers given herein are true and complete to the best of my knowledge. I understand that the documentation of all previous experience and education must be submitted to the HartfordSchool District within 30 days of hire for adjustments to salary to be made.

I authorize the investigation of all statements contained in this application that the HartfordSchool District may deem necessary in arriving at a decision regarding my employment.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire whether applications are being accepted at that time.

I understand that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee, in writing.

In the event of employment, I understand that false or misleading information given in this or other application materials or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

______

Signature of ApplicantDate

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