New Employee Worksheet

Employee Worksheet

Collins Career Technical Center
Note: This form is configured so you can stop anytime and return to complete it later. Just ensure that you have listed your email address, and you will be sent a link that you can use to complete it.
Job ID
Applicant ID
Preferred First Name
If different from your legal name.
Is this your legal first name?
Legal First Name
Middle Name
Note: Use * if you do not have a middle name
Legal Last Name
Maiden Name
Address
Street Address
City
State
Zip Code
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email
example@example.com
Date of Birth

MonthDayYear
Position
Your official title would be whatever was used in your welcome email.
Gender

Other
Marital Status

Education and Experience

Prior Employment

Rows	Business or School District	Subjects/Grades Taught or Occupational Experiences	Start Date	End Date
Most Recent
2nd Recent
3rd Recent
Other

Years of Military Service
Are you anticipating retirement?
Highest Level of Education
Do you have a bachalor's degree with more than 150 credit hours?
I have a master's degree with a total of Hours credit hours.

Traditional Education

Rows	Name of School	Major	Degree	# of Years Attended	Completed?
High School
Career-Tech
Undergraduate
Graduate

Non-Traditional Education

Rows	Name of School	Certtificate, Credential, or Degree Earned
Apprenticeship
Correstpondence
Evening
Extension

Number of Years with LCJVSD
Number of Years with Other Districts
Total Number of Years Teaching

Licensure Plan Agreement
I First Name* Last Name* acknowledge that my employment at Collins Career Technical Center is contingent upon my valid license for the position I have accepted.
1. Salary Scale Restrictions: I understand that my placement on the salary scale may be restricted. I may only be eligible for step increases once I obtain and maintain the required valid license for my position. I will be eligible for grade updates based on additional degrees or qualifications earned during this period.
2. Temporary Licensure: I must acquire and maintain temporary licensure, such as a paraprofessional or substitute teacher license, as determined during my onboarding into the licensure plan.
3. Licensure Plan: I agree to participate in a licensure plan with regular check-ins to assess my progress toward obtaining the required license.
4. Responsibility for Licensure Costs: I understand that I am responsible for obtaining and maintaining the required licenses.
5. Monitoring and Evaluation: My progress will be regularly evaluated to determine if I am on track or off track.
  1. On Track: If I am on track, I will continue collaborating with my supervisors and comply with the licensure plan to be eligible for re-employment each year.
  2. Off-Track: If I am off track, I will collaborate with my supervisors to create a plan to get back on track. Failure to return to an on-track status may result in termination and/or non-renewal.
6. Support: The school will provide support through the licensure plan to assist me in obtaining the required licensure.
I confirm my understanding and agreement to the above terms and conditions. Maintaining the required licensure is my responsibility and a condition of my continued employment.

Emergency Contact Information
Contact #1
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact #2
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact #3
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Primary Care Doctor

First NameLast Name
Preferred Hospital Old
Preferred Local Hospital

Almost Done!
Upload a Photo of Yourself (Optional, but Encouraged)

Note: This photo will be sent to the staff to welcome you to the distirct.
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Employee Acknowledgement and Certification Agreement

By signing below I confirm that all information provided in this document, including personal details, employment history, and qualifications, is accurate and truthful to the best of my knowledge. I understand that the accuracy of this information is crucial to my continued employment. Any false, misleading, or incomplete information may result in the termination of my employment or withdrawal of any employment offer, if applicable.

I also acknowledge that:

I have disclosed any criminal background information or legal proceedings that may impact my employment in compliance with applicable laws, including Ohio Revised Code 3319.39, which mandates background checks.

I am responsible for notifying the district of any changes in my personal information, such as my address, phone number, and emergency contacts, during my employment.

I understand that failing to provide accurate information or notify the district of any updates may result in disciplinary action, including termination.

Confidentiality and District Property:

I acknowledge my responsibility to maintain the confidentiality of all proprietary, sensitive, and confidential information of the Lawrence County Joint Vocational School District during and after my employment by LCJVSD Board Policy and the Family Educational Rights and Privacy Act (FERPA). I also agree to return all district property, including but not limited to technology, documents, keys, and access cards, upon the conclusion of my employment.

Employee Signature: I confirm that I have read, understood, and agree to the above-mentioned terms.
Sign Here
Should be Empty:

Employee Worksheet

Address

Licenseure and Certifications

First/Primary Educator License or Certification

Second License or Certification

Third License or Certification

Education and Experience

Licensure Plan Agreement

Emergency Contact Information

Contact #1

Contact #2

Contact #3

Physician Information

Almost Done!