ELMIRA CITY SCHOOL DISTRICT
"Preparing Students for the Future"
APPLICATION FOR EMPLOYMENT
* Complete all required areas
Name
*
First Name
Middle Name
Last Name
Maiden
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
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Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Phone
*
Cell Phone
Email Address
*
example@example.com
Position applying for: (check all that apply)
*
Bus Attendant
Bus Driver Trainee
Bus Driver
Clerical
Custodial
Food Service
Nursing
School Monitor
Teacher Aide
Sub Bus Attendant
Sub Bus Driver
Sub Clerical
Sub Custodial
Sub Food Service
Sub Teacher Aide
Other
* Current Employee: Please indicate if the request is a transfer or promotion and specify the position and building.
TRANSFER
PROMOTION
Position
Building Preference (if any)
* Current ECSD employee's may skip to our policy statement and sign and date.
EDUCATION:
Name & Address
From - To
(Mo. & Yr.)
Degree Awarded/GED #
High School or GED
College/Graduate School or other Education
WORK EXPERIENCE
Employer 1
Date
-
Month
-
Day
Year
Date
Date
-
Month
-
Day
Year
Date
Employer 1
Employer Name
Phone
Job Title
Supervisor Name & Title
Reason for leaving
Job Duties
WORK EXPERIENCE
Employer 2
Date
-
Month
-
Day
Year
Date
Date
-
Month
-
Day
Year
Date
Employer 2
Employer Name
Phone
Job Title
Supervisor Name & Title
Reason for leaving
Job Duties
References: List three (3) individuals familiar with your abilities:
Name
Address
Phone Number
1.
2.
3.
IT IS THE POLICY OF THE ELMIRA CITY SCHOOL DISTRICT TO PROVIDE FOR AND PROMOTE THE EQUAL OPPORTUNITY OF EMPLOYMENT, COMPENSATION, AND OTHER TERMS AND CONDITIONS OF EMPLOYMENT WITHOUT DISCRIMINATION BECAUSE OF AGE, RACE, CREED, COLOR, NATIONAL ORIGIN, SEX, DISABILITY, MARITAL STATUS OR CRIMINAL RECORD.
Have you ever been convicted of any crime (felony or misdemeanor)?
*
YES
NO
* If you answered "yes", give a full explanation. You will not necessarily be disqualified. Each case is evaluated on an individual basis in relation to the duties and responsibilities of the position for which you have applied. Omit parking or speeding violations assigned a fee of $50.00 or less and any other adjudicated in Juvenile Court or under a Youthful Offender Law.
STATEMENT:
I declare that all statements made in this application are true and complete to the best of my knowledge. I understand that any false statements made on this application or in interviews will result in immediate rejection or discharge from employment. I authorize the Elmira City School District to contact schools/college and former employers cited in the statement contained in this application for employment as may be necessary in arriving at an employment decision. I understand the acceptance of this application for employment by the Elmira City School District does not constitute or imply a commitment or willingness to offer employment to me in this or any other position. When required, I agree to take a drug screen test and comply with fingerprinting and authorize the release of these confidential test results to Elmira City School District.
DATE
*
/
Month
/
Day
Year
Date
SIGNATURE
*
Administration Building 430 W. Washington Ave. Elmira, NY 14901 PHONE: (607)735-3000 FAX: (607)735-3009
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