Application for Classified Employment

Application for Classified Employment

The Hicksville Exempted Village School District is dedicated to the provision of equal educational opportunities and equal employment opportunities without regard to race, creed, economic status, national origin, sex or handicap.

Personal Information
Personal Information
Position Desired
Certification or License Information (CDL, Aide Certificate, ASFS Food Service Certificate, etc.)
Name

First NameLast Name
Email
example@example.com
Present Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.
I would like to be considered for:

Full TimePart TimeSubstitute
In the following areas:

SecretarialCustodialEducational AideBus DriverFood ServiceMaintenance

	Yes	No
Are you currently on “Lay-off” status and subject to recall?
Are you physically or otherwise unable to perform the duties of the job for which you are applying?
Are you currently employed?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment

On what date are you available for work?

MonthDayYear
Date
Education

Education
High School Attended
Did you receive a High School Diploma?

YesNo

	College/University	Date	Degree
1
2
3

Additional Training – List any additional training related to the position for which you are applying

Military
Military
Have you served in the military?

YesNo
List active service dates
Service Branch
Honorably Discharged   Yes   No
Rank at Discharge
Significant duties/honors

References
References

Include Principals, Superintendents, Supervisors, or others for whom you have recently worked

	Name	Position	Phone
1
2
3
4

Work Experience
Work Experience (List Current experience first)
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Phone Number of Supervisor
Please enter a valid phone number.
Final Salary
Reason for Leaving
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Phone Number of Supervisor
Please enter a valid phone number.
Final Salary
Reason for Leaving
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Phone Number of Supervisor
Please enter a valid phone number.
Final Salary
Reason for Leaving
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Phone Number of Supervisor
Please enter a valid phone number.
Final Salary
Reason for Leaving
Do we have permission to contact your current employer?

YesNo

Special Skills and Qualifications
Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience

Other Considerations
Other Considerations
Have you ever worked for or applied for a position with the Hicksville Exempted Village School District?

YesNo
Dates of Application or Employment
Under what name?
Write a brief statement indicating why you would like to be employed by the Hicksville Exempted Village School District.

Candidate's Statements
Read carefully before signing
I certify that all statements made by me in this application are true, complete and correct to the best of my knowledge. I am aware that any false statements, misrepresentations or omissions of the facts will be sufficient cause for dismissal. If I am hired, I am aware that this application becomes part of my official employment record.

I understand that the Hicksville Exempted Village School District may want to verify the statements that I have made in this application. I authorize investigation of all statements contained herein, and give my permission for the Hicksville Exempted Village School District to request and review any of my employment records from previous employers, court records, and police records from any local, state or federal agency keeping such records. If Hicksville Exempted Village School District makes an offer of employment to me, I authorize the Hicksville Exempted Village School District, either at that time or any time during my employment, to request and review any of my medical records as needed. I shall execute any and all documents necessary to authorize production of said medical records, including but not limited to release forms required by the custodian of said medical records. I also authorize the Hicksville Exempted Village School District to obtain oral and written reference checks from the persons listed on this application (from all previous employers and from persons listed as personal references), and authorize any such persons to give the Hicksville Exempted Village School District any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from liability for any damage that may result from furnishing the same to the Hicksville Exempted Village School District.

I also authorize the Hicksville Exempted Village School District to obtain information regarding my record with the Bureau of Motor Vehicles if the job for which I am applying will require driving as part of my job duties.

I agree that any claim or lawsuit relating to my service with the Hicksville Exempted Village School District must be filed, no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.

The Hicksville Exempted Village School District will provide equal opportunities for employment, retention and advancement of all personnel regardless of race, color, creed, national origin, citizenship status, political affiliation, age, sex or disability that can be reasonably accommodated.
Signature

Clear
Date

MonthDayYear
Date
Hicksville Exempted Village School District Precondition to Employment
Should you come under final consideration for a position in the Hicksville Exempted Village School District, Ohio Revised Code 3319.39 requires the District to conduct a criminal history record check and requires you to submit a set of fingerprints to the Bureau of Criminal Identification and Investigation. This statute further requires the district to request information from the Federal Bureau of Investigation if you have not been a resident of the State of Ohio exclusively for the five-year period immediately prior to this date. The statute also authorizes the District to conduct a criminal history check with the Federal Bureau of Investigation even if you have been a resident of the State of Ohio for the previous five years. (Applicant is responsible for the cost of all background record checks.
Have you lived in Ohio exclusively for the past five years?

YesNo
List all residences for the past five years
Signature

Clear
Date

MonthDayYear
Date
Pursuant to the same Ohio Revised Code 3319.39, employment by any public or chartered non public school in the State of Ohio is conditioned on the applicant satisfactorily passing the criminal history record check. Due to the length of time required for completion of any required/requested records check, it may occasionally be necessary to employ a person prior to the Board of Education having received the results of the criminal records investigation. In these cases, the Board of Education shall rely on the applicant information provided in the employment application. However, by signing this document below, I specifically agree that if I am employed by the Board of Education prior to its receipt of a response from BCI/FBI, my employment shall be contingent upon subsequent receipt by the Board of Education of a report from BCI/FBI which is not inconsistent with my answer to the above question. In the event I have been employed prior to the Board of Education having received a report from BCI/FBI, and a subsequent report from BCI/FBI is received which is inconsistent with my answer to the above questions, I specifically agree that the action of the Board of Education employing me shall be void without any further act by either party, and that my employment will terminate immediately without the necessity of proceedings to formally terminate my contract of employment.
Signature

Clear
Date

MonthDayYear
Date

Statement of Job Applicant Regarding Criminal Record
Statement of Job Applicant Regarding Criminal Record

(O.R.C. 3319.39)
I, Enter Full Name , have not been convicted of, or entered a guilty plea to, any of the following offenses or any prior or existing laws of Ohio which are substantially similar or any prior or existing laws of another state or the federal government which are substantially similar.
Or

ANY FELONY, OR ANY OFFENSE OF VIOLENCE, THEFT OFFENSE,OR DRUG ABUSE OFFENSE, UNDER EITHER STATE LAW OR ANYSIMILAR MUNICIPAL ORDINANCE, THAT IS NOT A MINOR MISDEMEANOR.
Signature

Clear
Date

MonthDayYear
Date
If you cannot sign this form for any reason please write an explanation on a separate page or discuss directly with the hiring officer.
Have you ever been charged with one of the offenses listed above, and subsequently been convicted of, or pleaded guilty or no contest to, a lesser offense based on the same incident?

YesNo
Please Give Details
Have you ever been convicted of, or pleaded guilty or no contest to, an ATTEMPTED version of any of the offenses listed above?

YesNo
Please Give Details
Have you ever been subject to an investigation for child abuse conducted by a Children’s Services agency or a law enforcement agency?

YesNo
Please Give Details
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Application for Classified Employment

Personal Information

Education

Military

References

Work Experience (List Current experience first)

Special Skills and Qualifications

Complete the area below

Secretary/Educational Aide

Bus Driver

Food Service

Other Considerations

Read carefully before signing

Hicksville Exempted Village School District Precondition to Employment

Statement of Job Applicant Regarding Criminal Record