List the universities you have attended
(Begin with the most recent)
TEACHING AND OTHER EMPLOYMENT EXPERIENCE (list your most recent experience first and work back)
NOTE: If you answer YES for items "A ‐ G", please provide the date, explanation of the violation, disposition of the arrest or charge(s), place of occurrence, and the name and address of the police department or court involved.
Notice: The Crime Control Act of 1990, Public Law 101‐647 (codified in 42 United States Code 13041), requires that employment applications for child care positions have applicants sign a receipt of notice that a background check will be conducted as a condition of employment.
Native American Preference. Applications submitted will be shredded 6 months after application date, if not hired.
I authorize the Pueblo of Laguna Department of Education to obtain any record of criminal history with the understanding that such information held in confidence and used solely for the purpose of evaluating my application. I certify that my responses to these questions are made under the Federal penalty of perjury, which is punishable by fines or imprisonment, and that I have received notice that a criminal check will be conducted. I understand my right to challenge the accuracy and completeness of any information contained in the report. I affirm that all the information contained in this application is true and complete and that any misrepresentation, falsification or omission shall be cause for dismissal from, or refusal of employment. I hereby authorize the Pueblo of Laguna Department of Education to request any information from my previous employer(s) and I authorize any references to release such information.