SERRC Application Form

SERRC Employment Application
Personal Information:
Full Name*

First NameMiddle NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Physical Address (if different than above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Date You Can Start

MonthDayYear
Date
Position Applying For*
Education/Skills/Qualifications:
High School
Name of High School Attended
HS Location
HS Graduation Status:

YesNoOther
College/Trade School/Other
Name of College/University/Trade School/Community College Attended
Years Attended:
Degree Achieved
College/Trade School/Other
Name of College/University/Trade School/Community College Attended
Number of Years Attended
Degree Achieved
List any professional licenses, certificates or credentials and their expiration. Examples: CPA, Contractor, RN, Teaching Certificate
Professional Licenses/Certificates/Credentials
Skills
List any relevant skills - languages, software familiarity..etc.
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Dates Employed: : Date toDate
Reason for Leaving?
Current Salary ($)
Rate

HourlyMonthlyAnnualTemp/Contract
May We Contact?

YesNo
Job Duties
Previous Employment:

List most recent employment first
Previous Employer
Name of Previous Employer
Position
Dates Employed: : Date toDate
Previous Wage ($)
Rate

HourlyMonthlyAnnualTemp/Contract
Reason for Leaving?
May We Contact?

YesNo
Job Duties
Previous Employer
Name of Previous Employer
Position
Dates Employed: Date to Date
Previous Wage ($)
Rate

HourlyMonthlyAnnualTemp/Contract
Reason for Leaving?
May We Contact?

YesNo
Job Duties
List 3 Professional References:

Including your most recent/current Supervisor
Reference 1
Name of Reference
Relationship
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference 2
Name of Reference
Relationship
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference 3
Name of Reference
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Cover Letter & Resume (Optional):
Cover Letter

Cancelof
Resume

Cancelof
Disclosures:
Are you authorized to work in the US?*

YesNo - If no, please explain below
Will you now or in the future require sponsorship for employment visa status?*

NoYes - If yes, please explain below
Are you currently under contract with a district?*

NoYes - If yes, please explain below
Have you ever had any indicated finding of child abuse filed in your name?*

NoYes - If yes, please explain below
Does your name appear on any Sex Offender Database in any state or country?*

NoYes - If yes, please explain below
Have you ever failed to be rehired, been terminated, been asked to resign, or resigned to avoid termination?*

NoYes - If yes, please explain below
Have you ever been arrested, charged or convicted of a criminal offense other than a minor traffic violation?*

NoYes - If yes, please explain below
If you answered 'Yes' to any of the disclosures please explain:
Send Application:
By clicking the submit button below candidate authorizes the employer to conduct an investigation of candidate pursuant to The School Code to determine whether candidate has been convicted of any criminal or drug offenses as outlined in such statute, and, upon request, agrees to execute an investigation authorization form as a condition for candidate’s employment. The School Code also stipulates that the School District perform a check on the Statewide Sex Offender Database. Candidate may not be employed unless such investigations have been initiated.

I certify that the information given by me in this application is true in all respects, and I agree that if the information provided is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in the application to verify my statement, and I authorize past employers, all references and any other person to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
Date

MonthDayYear
Date
Signature

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SERRC Employment Application

Personal Information:

Education/Skills/Qualifications:

Current Employment:

Previous Employment:

List 3 Professional References:

Cover Letter & Resume (Optional):

Disclosures:

Send Application: