This is not an application for employment.

 

To apply for a job visit:

PCSD Employment Page

As a citizen of the State of Florida and the United States of America, and being employed by or an officer of Putnam County School District, and a recipient of public funds as such an employee or officer, do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida.

 

YOU WILL SIGN IN THE PRESENCE OF A NOTARY

DURING YOUR ONBOARDING SESSION

The Putnam County School District is authorized to collect, use or release social security numbers (SSN) of employees and other individuals*** for the following purposes, which are noted as either required or authorized by law to be collected. The collection of social security numbers is either specifically authorized by law or imperative for the performance of the District's duties at. §119]. and responsibilities as prescribed by law [Fla. St

1. Employment eligibility, report to IRS, SSA, UC, and FAWI, including for W-4s and  I-9s

2. Receipts to employees for wages and statements required in the case of sick pay paid by third parties

3. Verification of an alien's eligibility for employment, including I-9.

4. Income tax withholding (including for annuity and sick leave) and/or payroll deductions on Form W-2

5. Teacher retirement system benefits and contributions

6. Retirement contributions are required for enrollment in Florida Retirement System (FRS) Investment Plan, second election retirement plan enrollment, or for participation in and contributions to FRS

7. Reports pertaining to deferred vested retirement programs

8. Payments and plans relating to the retiree prescription drug subsidy under 42 C.F.R. § 423.34 and 42 C.F.R. 423.886

9. Educator certification or licensure application, renewal, or add-on, or non-employee registration for professional development for in-service points or incentive pay

10. Criminal history, Level 1 and level 2 background checks/identifiers for processing fingerprints by Department of Law Enforcement, if SSN is available

11. Registration information regarding sexual predators and sexual offenders

12. Reports on staff required to be submitted to the Florida Department of Education (DOE), including but not limited to Out-of-County/Out-of-State Verification of Highly Qualified

13. Social Security contributions

14. State directory of new hires (including for determining support obligations and eligibility for several federal and state programs)

15. Notice to payor and income deduction notices for child support and/or alimony

16. Child Support Enforcement

17. Garnishment payment pursuant to a Notice of Levy

18. Request from depository for support payments

19. Record of remuneration paid to employees

20. Unemployment Benefits Compensation and short term compensation plan

21. Unemployment reports from District

22. Income information disclosure to HUD

23. Vendors/Consultants that District reasonably believes would receive a 1099 form if a tax identification number is not provided Including for IRS form W-9.

24. Tort claims and tort notices of claim against the school board

25. Reporting to and reports of Worker's Compensation injury or death, including for DWC-1

26. Worker's Compensation petitions for benefits and responses thereto

27. The disclosure of the Social Security Number is for the purpose of the administration of health benefits for a District employee or his or her dependents

28. The disclosure of the Social Security Number is for the purpose of the administration of a pension fund administered for the District employee's retirement fund, deferred compensation plan, or defined contribution plan

29. Use of motor vehicle information from the Department of Motor Vehicles for the District to carry out its functions and to verify the accuracy of information submitted by agents or employees to the District, including to prevent fraud, in connection with insurance investigations, and to verify a commercial driver's license

30. Authorization for direct deposit of funds by electronic or another medium to a payees

31. Identification of blood donors

32. Employee's and former employee's request for a report of exposure to radiation

33. Collection and/or disclosure are imperative or necessary for the performance of the District's duties and responsibilities as prescribed by law, including but not limited to password identification to the District's network

34. The disclosure of the Social Security Number is expressly required by federal or state law or a court order

35. The individual expressly consents in writing to the disclosure of his or her Social Security Number

36. The disclosure of the Social Security Number is made to prevent and combat terrorism to comply with the USA Patriot Act of 2001, Pub. L. No. 107-56, or Presidential Executive Order 13224

37. The disclosure of the Social Security Number is made to a commercial entity for the permissible uses set forth in the federal Driver's Privacy Protection Act of 1994, 18 U.S.C. Sec. 2721 et seq.; the Fair Credit Reporting Act, 15 U.S.C. Sec. 1681 et seq.; or the Financial Services Modernization Act of 1999, 15 U.S.C. Sec. 6801 et seq., provided that the authorized commercial entity complies with the requirements of Florida Statute § 119.

38. The disclosure of the Social Security Number is for the purpose of the administration of the Uniform Commercial Code by the office of the Secretary of State

*** Note, this form states the reasons for collecting, using or releasing the Social Security Numbers only of employees and individuals other than students, parents and volunteers. A separate written statement sets forth the reasons for collecting, using or releasing the Social Security Numbers of students and parents, and a separate written statement exists for collecting, using or releasing the Social Security Numbers of volunteers as part of the volunteer (VIPS) application.

NOTE: Pursuant to Florida Statute 943.0585 and 943.059 court-ordered expunction of criminal history records, persons to be employed in a position having direct contact with children must answer questions 4, 5 and 6. The School Board of Putnam County will receive information on all records that have been sealed, expunged, or where adjudication was withheld. To omit a response or to be untruthful in your responses, regardless of any previous information received from your attorney, will be considered falsification of your application and will result in your being terminated. If you wish to see counsel prior to completing this section, you may take this application with you.

ARREST #1

EXAMPLE OF CRIMINAL OFFENSES: Assault/battery, auto theft, disorderly conduct, domestic violence, DUI/DWI, fraud, (welfare, food stamps) loitering, prostitution/solicitation, robbery, shoplifting, theft (grand/petty) passing worthless checks.

NOTE: This is not a complete list and is intended to provide examples only. You must list all convictions including those in which adjudication was withheld and/or records were sealed /expunged.

By signing this document you certify that you have carefully read and fully understand each question and that all information contained herein is true and accurate. Your signature further certifies that there is no falsification of any information or omission of any information requested. You also understand that your fingerprints will be submitted to the Federal Bureau of Investigation for a complete criminal history background check.

By your signature, you authorize the Putnam County School District to conduct any investigation necessary to verify all information identified on this form. Your signature on this document provides for the release of any sealed or expunged records in your name by any court. Included in this grant of authority is your permission to contact any and all former employers and other persons acquainted with you or in possession of information concerning you to supply such information to the Human Resources Department.

By your signature, you certify that you know, understand, and agree that any false statement or omission of information requested will result in your immediate termination.

 

Please print on a blank sheet of paper if you have more than one arrest to report. You will have an opportunity to upload it at the end.

INSTRUCTIONAL EMPLOYEES (Teachers)

196 Day Probationary Period

1012.335 (1c) “Probationary contract” means an employment contract for a period of 1 school year awarded to instructional personnel upon initial employment in a school district. Probationary contract employees may be dismissed without cause or may resign without breach of contract. A district school board may not award a probationary contract more than once to the same employee unless the employee was rehired after a break in service for which an authorized leave of absence was not granted. A probationary contract shall be awarded regardless of previous employment in another school district or state.

As provided in Section 1012.335 (1)(c) 4 of the Florida Statutes, for any person newly employed as a member of the instructional staff beginning July 1, 2011, the initial annual contract shall be a probationary period during which time the employee’s contract may be terminated without cause or the employee may resign without breach of contract.

NON-INSTRUCTIONAL EMPLOYEES (Classified, Support, Administrative)

90 Day Probationary Period

Non-instructional employees are subject to a 90-day probationary period.

Advanced Degree Salary Supplement Pay Information

For Instructional Personnel and School Administrators hired after July 1, 2011

http://www.flsenate.gov/session/bill/2011/0736/billtext/er/pdf

 

The 2011 SB 736 Student Success Act addresses salary supplements for advanced degrees in the educator’s area of certification. The exact language reads as follows: “A District school board may not use advanced degrees in setting a salary schedule for instructional personnel or school administrators hired on or after July 1, 2011, unless the advanced degree is held in the individual’s area of certification and is only a salary supplement.”

The advanced degree supplement is not considered part of base pay.

What is Advanced Degree Pay?

According to the State Law that became effective July 1, 2011, instructional employees that are new to the District or that are rehired after a break in service may receive pay for advanced degrees provided the degree is held in an area of certification on their Florida Teaching Certificate.

Please review district policies by clicking the following links.

Nondiscrimination and Equal Employment Opportunity

 

Click here for Policy 1122,

Administration

 

Click here for Policy 3122,

Instructional

 

Click here for Policy 4122,

Support

 

Drug-Free Workplace

 

Click here for Policy 1124,

Administration

 

Click here for Policy 3124,

Instructional

 

Click here for Policy 4124,

Support

 

Code of Ethics and Principles of Professional Conduct of the Education Profession in Florida

 

Click here for Policy 1210,

Administration Standards of Ethical Conduct 

 

Click here for Policy 3210,

Instructional Staff Standards of Ethical Conduct 

 

Click here for Policy 4210,

Support Staff Standards of Ethical Conduct 

 

The Education Standards Commission has drafted the attached Code of Ethics and Principles of Professional Conduct which was adopted by the State Board of Education as rules on November 24, 1998. As a part of the Florida Administrative Code, these rules are enforced by the Education Practices Commission. Violation of the Principles of Professional Conduct can result in the revocation or suspension of the teaching certificate, probation, fine, or restriction of the scope of practice.

 

Use of Reasonable Force Policy Manual, Section 5000

 

Click here for POLICY 5630 - CORPORAL PUNISHMENT AND USE OF REASONABLE FORCE AND RESTRAINT

 

A teacher or other member of the staff shall assume such authority for the control of students who are assigned to him/her by the principal or designee and shall keep good order in the classroom.

Corporal Punishment

The use of corporal punishment is prohibited. Alternative disciplinary procedures, which may include timeout, peer review, or other forms of positive reinforcement should be used to bring about appropriate student classroom behavior. (see AP 5630A and AP 5630B)

Reasonable Force and Restraint

Instructional staff as well as support staff, within the scope of their employment, may use and apply reasonable force and restraint to quell a disturbance threatening physical injury to others, to obtain possession of weapons or other dangerous objects upon or within the control of the student, in self-defense, or for the protection of persons or property. Furthermore, administrators, instructional staff members, and support staff members shall not be criminally or civilly liable for any action carried out in conformity with State School Board rules and/or School Board policies regarding the control, discipline, suspension, and expulsion of students, including, but not limited to, any exercise of authority granted by this policy. Revised 10/21/14, Technical Change 11/1/16 Legal F.S. 1003.02, 1003.32, 1006.09, 1006.11 © Neola 2011

You will be required to sign a form acknowledging receipt of these policies and it will become part of your personnel record.

• It is your responsibility to notify your supervisor immediately of any workplace injury.

• Sign all required forms (first aid log, notice of injury form DWC-1, authorization for release of medical information, and fraud statement) all made readily available via your supervisor.

• Approved medical facilities are Express Urgent Care (formerly MedEx) or St John's Urgent Care ONLY.

• Communicate with those key people who help make this process simple and effective (supervisors, adjusters, physicians, and the coordinator in Human Resources, Deborah Crowley 386.312.4933)

• Notify our third-party administrator (PMA Management, TPA) of any changes to your address and telephone numbers

• Once your claim has been determined as compensable, an authorized physician will be provided, as well as payment for authorized medical treatment and care related to your injury. Treatment may consist of doctor visits, hospitalization, physical therapy, medical testing, prescriptions, prosthetics, travel expenses, etc.

• You must also notify Human Resources upon return to work. This is critical for uninterrupted pay status.

 

Third-party administrator, PMA Management, TPA 1.888.476.2669

 

I understand that if I have any questions or do not understand any part of the material I may contact Deborah Crowley at 386.312.4933 in Human Resources for assistance.

 

You will be required to sign a form acknowledging receipt of this information and it will become part of your personnel record.

Please be sure to see our insurance representative:

 

Tammy Collins

District Office

Phone 386.329.0661

If you are adding children and/or a spouse, we require copies of their birth certificates and social security numbers. If you are married, you will also be required to provide a copy of your marriage license in order to add your spouse.

 

You will be required to sign a form acknowledging receipt of this information.

Florida New Hire Reporting

 

State and federal law (409.2576 F.S. and 42 U.S.C. 653A) require all employers to report newly hired and re-hired employees to the Department of Revenue within 20-days of the employee's start date.

 

Questions? 

Florida New Hire Reporting Center

PO Box 6500

Tallahassee, FL 32314-6500

Phone (850) 656-3343, or toll-free from within Florida at (888) 854-4791

Monday through Friday from 8 AM to 5 PM Eastern Time

 

START HERE: Read instructions carefully before completing this form. The instructions must be available, either on paper or electronically, during the completion of this form. Employers are liable for errors in the completion of this form.

 

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

 

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

OR

OR

Preparer and/or Translator Certification (check one):

(Signature of preparer or translator and fields below must be completed when preparers and/or translators assist an employee in completing Section 1.)

If you use a preparer and/or translator, please print the I-9 form for his/her signature.

Click here:

E-Verify and I-9 List of Acceptable Documents

 

 I will provide the following document(s) to verify that I am legally allowed to work in the United States:

Please note: you are still required to bring a valid photo id and Social Security card for employment purposes, even if you use different documents for the I-9.

For more information please visit www.irs.gov/forms-pubs/about-form-w-4

 

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS.

Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, other details, and privacy.

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Reserved for future use.

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or

TIP:  If you have self-employment income, see page 2.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

If your total income will be $200,000 or less ($400,000 or less if married filing jointly)

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

 

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. If too little is withheld, you will generally owe tax when you file your tax return and may owe a penalty. If too much is withheld, you will generally be due a refund. Complete a new Form W-4 when changes to your personal or financial situation would change the entries on the form. For more information on withholding and when you must furnish a new Form W-4, see Pub. 505, Tax Withholding and Estimated Tax.

Exemption from withholding.  You may claim exemption from withholding for 2023 if you meet both of the following conditions: you had no federal income tax liability in 2022 and you expect to have no federal income tax liability in 2023. You had no federal income tax liability in 2022 if (1) your total tax on line 24 on your 2022 Form 1040 or 1040-SR is zero (or less than the sum of lines 27, 28, and 29), or (2) you were not required to file a return because your income was below the filing threshold for your correct filing status. If you claim exemption, you will have no income tax withheld from your paycheck and may owe taxes and penalties when you file your 2023 tax return. To claim exemption from withholding, certify that you meet both of the conditions above by writing “Exempt” on Form W-4 in the space below Step 4(c). Then, complete Steps 1(a), 1(b), and 5. Do not complete any other steps. You will need to submit a new Form W-4 by February 15, 2024.

Your privacy. If you have concerns with Step 2(c), you may choose Step 2(b); if you have concerns with Step 4(a), you may enter an additional amount you want withheld per pay period in Step 4(c).

Self-employment. Generally, you will owe both income and self-employment taxes on any self-employment income you receive separate from the wages you receive as an employee. If you want to pay income and self-employment taxes through withholding from your wages, you should enter the self-employment income on Step 4(a). Then compute your self-employment tax, divide that tax by the number of pay periods remaining in the year, and include that resulting amount per pay period on Step 4(c). You can also add half of the annual amount of self-employment tax to Step 4(b) as a deduction. To calculate self-employment tax, you generally multiply the self-employment income by 14.13% (this rate is a quick way to figure your self-employment tax and equals the sum of the 12.4% social security tax and the 2.9% Medicare tax multiplied by 0.9235). See Pub. 505 for more information, especially if the sum of self-employment income multiplied by 0.9235 and wages exceeds $160,200 for a given individual.

Nonresident alien. If you’re a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

 

Step 1(c). Check your anticipated filing status. This will determine the standard deduction and tax rates used to compute your withholding. 

Step 2. Use this step if you (1) have more than one job at the same time, or (2) are married filing jointly and you and your spouse both work. 

If you (and your spouse) have a total of only two jobs, you may check the box in option (c). The box must also be checked on the Form W-4 for the other job. If the box is checked, the standard deduction and tax brackets will be cut in half for each job to calculate withholding. This option is roughly accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld, and this extra amount will be larger the greater the difference in pay is between the two jobs.

Multiple jobs. Complete Steps 3 through 4(b) on only one Form W-4. Withholding will be most accurate if you do this on the Form W-4 for the highest paying job.

Step 3.  This step provides instructions for determining the amount of the child tax credit and the credit for other dependents that you may be able to claim when you file your tax return. To qualify for the child tax credit, the child must be under age 17 as of December 31, must be your dependent who generally lives with you for more than half the year, and must have the required social security number. You may be able to claim a credit for other dependents for whom a child tax credit can’t be claimed, such as an older child or a qualifying relative. For additional eligibility requirements for these credits, see Pub. 501, Dependents, Standard Deduction, and Filing Information. You can also include other tax credits for which you are eligible in this step, such as the foreign tax credit and the education tax credits. To do so, add an estimate of the amount for the year to your credits for dependents and enter the total amount in Step 3. Including these credits will increase your paycheck and reduce the amount of any refund you may receive when you file your tax return.

Step 4 (optional).

Step 4(a). Enter in this step the total of your other estimated income for the year, if any. You shouldn’t include income from any jobs or self-employment. If you complete Step 4(a), you likely won’t have to make estimated tax payments for that income. If you prefer to pay estimated tax rather than having tax on other income withheld from your paycheck, see Form 1040-ES, Estimated Tax for Individuals.

Step 4(b). Enter in this step the amount from the Deductions Worksheet, line 5, if you expect to claim deductions other than the basic standard deduction on your 2023 tax return and want to reduce your withholding to account for these deductions. This includes both itemized deductions and other deductions such as for student loan interest and IRAs.

Step 4(c). Enter in this step any additional tax you want withheld from your pay each pay period, including any amounts from the Multiple Jobs Worksheet, line 4. Entering an amount here will reduce your paycheck and will either increase your refund or reduce any amount of tax that you owe.

PLEASE PROVIDE A VOIDED CHECK OR A LETTER FROM THE BANK FOR THE ACCOUNT LISTED ABOVE.

The rapid! PayCard® Mastercard is issued by MetaBank®, Member FDIC, pursuant to license by Mastercard International Incorporated. Prepaid card can be used wherever Debit Mastercard is accepted. Mastercard is a registered trademark of Mastercard International Incorporated. Important Information for opening a Card account: To help the federal government fight the funding of terrorism and money laundering activities, the USA PATRIOT Act requires all financial institutions and their third parties to obtain, verify, and record information that identifies each person who opens a Card account. What this means for you: When you open a Card account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

 

I authorize Putnam County School District to withhold the indicated amount(s), if available, from my pay, and deposit directly into the account(s) shown and/or I hereby authorize Putnam County School District to assign a rapid! PayCard and initiate credit entries and any correcting entries to my assigned rapid! PayCard account. The direct deposit(s) will be made on each payday, unless I notify Putnam County School District in writing of my intent to cancel. Upon Putnam County School District’s receipt of a request to cancel a direct deposit authorization, it shall become effective after a reasonable opportunity to act upon it.

In the event funds are deposited erroneously into my account, I authorize Putnam County School District to debit my account(s) not to exceed the original amount of the credit.

I understand that Putnam County School District reserves the right to refuse any direct deposit request. I also understand that all direct deposits are made through the Automated Clearing House (ACH), and that funds availability is subject to the terms and limitations of the ACH as well as my financial institution.

Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.