Support Staff (Non-Certified) Application

Support Staff (Non-Certified) Application

EMPLOYMENT HISTORY

Please list employment beginning with MOST RECENT.
Employer #1
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer Email
example@example.com
Position(s) Held
Dates Employed Here
Reason(s) Left
Employer #2
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer Email
example@example.com
Position(s) Held
Dates Employed Here
Reason(s) Left
Employer #3
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer Email
example@example.com
Position(s) Held
Dates Employed Here
Reason(s) Left

REFERENCES

Please list 3 individuals who are qualified to evaluate your job qualifications. NO RELATIVES.
Reference #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Occupation/Relationship to You*
Reference #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Occupation/Relationship to You*
Reference #3*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Occupation/Relationship to You*

RESUME (OPTIONAL)

Uploads must be in a PDF format.
If you would like to upload your resume, please do so here.

Cancelof

SIGNATURE

Your signature below constitutes authorization to check your employment history, including without limitation, evaluations, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any private or public employer or any state, local or federal agency. It further authorizes those persons, agencies or entities that the Community School Corporation of Eastern Hancock County contacts in connection with your employment application to fully provide any information on the matters set forth above. You expressly waive in connection with any request for or provision of such Information, any claims, including without limitations, defamation, emotional distress, invasion of privacy, or interference with contractual relations that you might otherwise have against the Community School Corporation of Eastern Hancock County, its agents and officials or against any provider of such information. I certify that the information on this application is true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries as may be necessary in arriving at an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may be sufficient cause for dismissal.
Signature*

Clear
Date*

MonthDayYear
Date
The Community School Corporation of Eastern Hancock County assures that it will comply fully with all requirements of Title VI of the Civil Rights Act of 1964, Title IX of the 1972 Education Amendments, and Section 504 of the Rehabilitation Act of 1973 as amended. Eastern Hancock County further assures that it will not discriminate against any person in the United States on the basis of race, color, sex, national origin, religion, or handicap, nor will anyone be subjected to discrimination in admission or access to, or treatment or employment in the conduct of its programs and activities and operation of its facilities.

For inquiries regarding compliance as well as grievances on the above assurances contact:
Superintendent, 10370 E. 250 N. Charlottesville, IN 46117 317-936-5444 or Office of Civil Rights, U.S. Department of Education, Washington, D.C.
Should be Empty: