• SES Certified Employment Application

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  • Education History

    List school name, date of graduation, diploma type, beginning with high school.
  • Employment History

    List employer name, dates of work, and position type beginning with most recent.
  • References

    List at least three references. Name, Relationship, Phone Number
  • Memberships, Affiliations, Community Activities

    List Organizations and how you participate in those organizations
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  • Request for Background Information

  • Employment with Shelby Eastern Schools involves contact with our student population.  We ask that you complete the questions below to help us evaluate your suitability to work with these students.  All applicants for employment are exptected to provide us with this information; you are not being singled out for closer inspection.  This request is part of the application itself and any misrepresentation or omission of fact may be grounds for disqualification from further consideration or for terminiation from employment reglards of when the misrepresentation or omission is discovered.  "The convication of a crime, an arrest for a crime, any information obtained through the release of investigatory record, or any affirmative answer provided by you on this form, shall not be an automatic bar to employment.  The school corporation will consider the nature of any conviction or alleged conduct underlying the arrest, investigatory record, or affirmative response, the date of the alleged conduct in question, your intervening conduct and the relationship between the conviction or alleged conduct underlying the arrest, investigatory record, or affirmative response and the position for which you are applying."

    1. If you are now working, is your conduct as an employee or the quality of your work the focus of any investigation by your current employer?

     

  • 2. Have you ever resigned from a job after being disciplined by your employer or after being offered the opportunity to resign rather than be terminated?

  • 3. Have you ever been investigated for, charged with or plead guilty or "no contest" to any crime involving the sexual abuse of any person or indecency with a minor?

  • 4.  Have you ever been charged with a crime, other than a minor traffic offense, where the court has deferred further proceedings without entering a finding of guilt and placed you on probation or in a public service or education program?

  • I authorize Shelby Eastern Schools to check my employment history, including without limitation, references checks, and to seek the release of investigatory information, including a "limited criminal history", possessed by any private or public employer or any local, state or federal agency. I authorize these private or public employees or local, state or federal agencies to provide the corporation any information they may release concerning the matters described herin, and I will cooperate to the extent necessary to obtain the release of information.

    I expressly waive in connection with any request for, or the providing of such information, any claims or causes of action, including without limitation, defamation, infliction of emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against Shelby Eastern Schools, its officials, employees, trustees or agents, or against any provider of such information.

    I have read this authorization and release of all claims, and I expressly agree to the terms set out herin.

     

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