ECSD JOB APPLICATION

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 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
School Building Preference:

No Preference Diven Elementary Fasset Elementary Pine City Elementary Riverside Elementary Beecher Elementary Broadway Elementary Coburn Elementary Hendy Elementary Ernie Davis Academy Broadway Academy Elmira High School Maintenance Bus Garage Administration
* 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 *

Clear
Administration Building 430 W. Washington Ave. Elmira, NY 14901 PHONE: (607)735-3000 FAX: (607)735-3009
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ELMIRA CITY SCHOOL DISTRICT

APPLICATION FOR EMPLOYMENT

EDUCATION:

WORK EXPERIENCE

WORK EXPERIENCE

STATEMENT: