Perandoe Employment Application
Perandoe Special Education District is an Equal Opportunity Employer. This application will be maintained for 12 months only.
Date
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Month
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Day
Year
Date
Name
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First Name
Middle Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address (optional):
Applying for:
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Full-time
Part-time
Position(s) applying for:
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Administrative Assistant
Bookkeeper
Cook
Maintenance
Occupational Therapist
Certified Occupational Therapist
Physical Therapist
Physical Therapist Assistant
Paraprofessional (aide)
School Psychologist
School Social Worker
Speech and Language Therapist
Substitute
Teacher
Other
If "Other", please indicate what position below
Have you ever worked for this school district before?
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Yes
No
If "Yes", when and where?
Date available to Start:
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Month
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Day
Year
Date
Are you available to work:
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Full-time
Part-time
Days
List any day or hours you are unable to work.
Lisa any friends or relatives working here (include name and relationship)
Please indicate your source of referral:
*
District Employee
Newspaper
Employment Agency
Contacted on Own
Other
If "Other", please indicate below.
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United States Military Service
If "Yes" to the first questions, complete all of the corresponding questions. If "No", continue to the next section.
Do you have United States Military Experience?
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Yes
No
Branch:
Date Entered:
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Month
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Day
Year
Date
Date Discharged:
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Month
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Day
Year
Date
Rank at time of discharge:
Special skills or training from the service:
Present military status:
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Education and Training
Please list educational Institutions (high school, technical schools, and college) attended, beginning with the most recent.
Educational Institution #1 - List Name, Location, Number of Years Completed and Degree Earned/Major
*
If you have more than one educational institution, please list the rest below. If not, continue to the next section.
Educational Institution #2 - List Name, Location, Number of Years Completed and Degree Earned/Major:
Educational Institution #3 - List Name, Location, Number of Years Completed and Degree Earned/Major:
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Work Experience
List below your previous employers, starting with the most current one.
Company Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position:
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Estimated Earnings Beginning:
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Estimated Earnings Ending:
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Start Date:
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Month
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Day
Year
Date
End Date:
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Month
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Day
Year
Date
Supervisor Name and Title:
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Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Leaving:
*
If you have additional employers to add, complete the fields below. If not, continue to the next section
Company Name 2:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position:
Earnings Beginning:
Earnings Ending:
Start Date:
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Month
-
Day
Year
Date
End Date:
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Month
-
Day
Year
Date
Supervisor Name and Title:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Leaving:
Company Name 3:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position:
Earnings Beginning:
Earnings Ending:
Start Date:
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Month
-
Day
Year
Date
End Date:
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Month
-
Day
Year
Date
Supervisor Name and Title:
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Leaving
If you have other places you have worked besides those listed above, please list any additional experiences.
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Professional References
Include three professional references who supervised your previous work (principals, supervisors, superintendents). Include Name, Address, City/State, Position & Name of Business, and Phone Number,
Professional Reference 1:
Professional Reference 2:
Professional Reference 3:
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THIS SECTION MUST BE COMPLETED AS PART OF THE APPLICATION PROCESS. PLEASE MAKE CERTAIN THAT YOU ANSWER ALL OF THE QUESTIONS TRUTHFULLY. OMISSION OR FALSIFICATION OF ANY CRIMINAL INFORMATION WILL BE GROUNDS FOR IMMEDIATE DISMISSAL.
Have you ever been convicted of an offence other than a minor traffic violation?
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Yes
No
If "Yes", when, where and disposition of the conviction?
Note: An application for employment is not obligated to disclose sealed or expunged records of conviction or arrest. You are also not obligated to disclose expunged juvenile records of adjudication or arrest.
Have you ever been convicted of, had adjudication withheld, plead no contest to, or entered a pretrial intervention program for a misdemeanor or felony criminal charge?
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Yes
No
If "Yes", please explain.
Have you ever been the subject of an indicated report by DCFS or a similar state agency?
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Yes
No
If "Yes" please explain.
Have you ever been suspended without pay, dismissed from employment, or resigned while an investigation was in progress for possible disciplinary action?
*
Yes
No
If "Yes", please explain where and when.
By signing below, I understand that the information provided is true and correct, and that any misstatements or omission of material facts in the application or the hiring process may result in discontinuation of the hiring process or the termination of employment, no matter when discovered. I agree that the district shall not be held liable in any respect if my employment is terminated because of false statements, answers, or omissions made by me in this application.I authorize the school district to analyze the truthfulness of all statements made on this application, complete reference checks from my current and former employers, and others that may provide information regarding my education and experiences. I also authorize a criminal background, sex offender, and other checks required by the Federal and State government and the school code. I acknowledge that consideration for employment is contingent on these background check(s) results. In addition, I give my consent for all contacted persons, including current and former employers, to provide information concerning this application, and I release each such person from liability for providing information to the school district.I hereby attest that all statements made by me above are true to the best of my knowledge, and I agree to the terms noted above.
Signature
Today's Date
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Month
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Day
Year
Date
Submit
Submit
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