Poplar School District Certified Application

Poplar School District Certified Application
The following application material must be submitted to be considered:

1.      A completed Application Form.

2.     A cover letter.

3.      Three (3) letters of professional reference OR

4.     Your university placement file.

5.      A copy of your transcripts.

6.        A copy of your current certificate.

·         Application materials may be submitted in person, by mail, email, or fax.

·         All jobs are posted until filled.

·         Application and supporting materials will not be returned.

·         Background checks will be performed on all candidates. The Disclosure and Authorization to Release Information form and Affirmative Action Information will be kept separate and apart from the application during the screening process.

Submit completed applications to:

District Office or email to HR@poplarschools.com

DIRECT ALL QUESTIONS TO THE BUILDING LEVEL ADMINISTRATOR

John Wetsit-Elementary Principal (K-4): John.Wetsit@poplarschools.com

Morgan Norgaard-Middle School Principal (5-8): Morgan.Norgaard@poplarschools.com

Frank Gourneau-High School Principal (9-12): Frank.Gourneau@poplarschools.com
Equal Opportunity Employer

The Poplar School District prohibits discrimination against or harassment of any person employed by or seeking employment with the school district because of race, creed, religion, color, political affiliation or national origin or because of age, physical or mental disability, marital status, or gender distinction. People of disability may request reasonable accommodation in the hiring process by contacting the school district personnel office.

Proof of Employability, TB Test

Any applicant chosen for employment must be able to produce a social security card, driver’s license, or some other acceptable form of certification of employment eligibility in the United States pursuant to Form I-9 of the U.S. Department of Justice. Similarly, a selected applicant must provide certification of having received tuberculin (TB) test within the past year. Verification must include the date of the test, the results of the test, and the signature of the person who conducted the test. It is policy to require verification of a TB from any candidate chosen from employment and to require submitted documentation of the results of a tuberculin (TB) test within seven days of employment.

Drug Free/Tobacco Free Policies

The school district is a drug and tobacco free school and, as such, requires all employees to adhere to specific drug free and tobacco free policies.
Date

MonthDayYear
Date
Social Security No.
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email
example@example.com
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Name
Date of Birth

MonthDayYear
Date
Gender
City
State
Zip Code
Marital Status
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employment Eligibility and Certifications
Do you have the legal right to work in the United States?
Are you able with or without reasonable accommodation to perform the functions of the job for which you are applying?
Have you ever been released or discharged from employment or resigned to avoid such release or discharge?
Criminal History Certification
If you answered yes to any certification or disclosure question, please explain
Please provide details regarding any release, discharge, or resignation to avoid discharge
If applicable, describe the functions of the job you are able to perform with or without reasonable accommodation
Have you ever been convicted of a crime other than a minor traffic violation?
Have you ever been subject to any criminal charge or pending criminal proceeding?
If you answered yes to any criminal history question, provide an explanation
Do you currently hold any certification or license required for the position?
If yes, list your current certification(s) or license(s) and issuing authority
Employment History
Most Recent Employer - Employer
Most Recent Employer - Position
Most Recent Employer - From Date

MonthDayYear
Date
Most Recent Employer - To Date

MonthDayYear
Date
Most Recent Employer - Responsibilities
Most Recent Employer - Reason for Leaving
Most Recent Employer - Supervisor Name
Most Recent Employer - Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Most Recent Employer - May Contact Supervisor
Second Most Recent Employer - Employer
Second Most Recent Employer - Position
Second Most Recent Employer - From Date

MonthDayYear
Date
Second Most Recent Employer - To Date

MonthDayYear
Date
Second Most Recent Employer - Responsibilities
Second Most Recent Employer - Reason for Leaving
Second Most Recent Employer - Supervisor Name
Second Most Recent Employer - Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Second Most Recent Employer - May Contact Supervisor
Third Most Recent Employer - Employer
Third Most Recent Employer - Position
Third Most Recent Employer - From Date

MonthDayYear
Date
Third Most Recent Employer - To Date

MonthDayYear
Date
Third Most Recent Employer - Responsibilities
Third Most Recent Employer - Reason for Leaving
Third Most Recent Employer - Supervisor Name
Third Most Recent Employer - Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Third Most Recent Employer - May Contact Supervisor
Most Recent Employer - Company Address
Most Recent Employer - City, State, Zip
Second Most Recent Employer - Company Address
Second Most Recent Employer - City, State, Zip
Third Most Recent Employer - Company Address
Third Most Recent Employer - City, State, Zip
Employment Gaps Explanation
Additional Employment History Notes
Education and Qualifications
Education and Qualifications
School Name
Location
Degree or Diploma Earned
Major or Area of Study
Dates Attended

MonthDayYear
Date
Did You Graduate?
GPA
Relevant Coursework
Academic Honors or Distinctions
Teaching Certificate or License
Certificate Number
Certificate or License Expiration Date

MonthDayYear
Date
Additional Certifications
Professional Development or Training
Special Skills or Qualifications
Other Education-Related Information
Attachments or Supporting Documents
References
Reference 1 Full Name

First NameMiddle NameLast Name
Reference 1 Relationship
Reference 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Email
example@example.com
Reference 2 Full Name

First NameMiddle NameLast Name
Reference 2 Relationship
Reference 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Email
example@example.com
Reference 3 Full Name

First NameMiddle NameLast Name
Reference 3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Background and Additional Disclosures
Have you ever been convicted of a crime?
If yes, please explain the conviction(s), including date, offense, and disposition.
Have you ever been arrested or charged with a crime?
If yes, please explain the arrest(s) or charge(s), including date and outcome.
Have you ever had a professional license, certificate, or permit denied, suspended, revoked, or surrendered?
If yes, please explain the circumstances.
Have you ever been the subject of an investigation by an employer, licensing agency, or law enforcement agency?
If yes, please provide details of the investigation.
Have you ever been dismissed, non-renewed, or resigned in lieu of termination from any employment?
If yes, please explain the circumstances.
Have you ever been subject to disciplinary action in any school district or other employer?
If yes, please describe the disciplinary action.
Do you authorize the District to conduct a background check and verify the information provided in this application?
Provide any additional disclosures or explanations relevant to your background check.
Authorization to Release Information
Additional disclosures
Signature
Employment Preference Form
Name

First NameLast Name
Social Security #
Position Applied for:
To claim preference under the Montana Veterans’ Employment Preference Act, complete the following. Providing information is voluntary but must be included with the application in order to claim employment preference. This information will be kept confidential and will only be used during the hiring process to provide the applicant employment preference. Applicants hired by the district will have this information placed in a separate confidential file.

1. Veterans’ Employment Preference provides the addition of 5% points or 10% points to the applicants score when a numerically scored selection procedure is used. Whenever a public employer uses a selection procedure other than a second procedure, the public employer shall give preference to a disabled veteran, eligible relative, or veteran, in that order over any nonpreferred applicant holding substantially equal qualifications.

2. To claim Veterans’ Employment Preference, you must be a U.S. Citizen and: A Veteran, if

1. You have been separated under honorable conditions; and

2. You have served more than 180 consecutive days of active duty other than for training in the Air Force, Navy, Marines, or Coast Guard (not including National Guard or Reserves) or a member of the reserves who served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized.

A Disabled Veteran, if

1. You have been separated under honorable conditions from active duty; and

2. You have an established Armed Forces service-connected disability OR are receiving compensation, disability retirement benefits, or pension from the U.S. Department of Veterans Affairs or military department, OR you have received a Purple Heart.

The spouse of a disabled veteran if the veteran’s disability prevents him/her from working. The unremarried spouse of a veteran or disabled veteran.

The mother of a veteran, if

1.                   THE VETERAN died under honorable conditions while serving in the Armed Forces; OR THE VETERAN has a service-connected, permanent, and total disability.

2.                   YOUR SPOUSE is totally and permanently disabled, OR YOU are the unmarried widow of the father of the Veteran.

3.           Check the attachment you have included to document the preference request.
Signature
Date

MonthDayYear
Date
AFFIRMATIVE ACTION INFORMATION – OPTIONAL
Providing this information is strictly on a voluntary basis. State law requires that employers keep records on the race and sex of applicants and employees to facilitate the enforcement of equal employment opportunity laws. This statement will be filed separately from all other records during the application screening process. As required by state law, it will be available only to the school district personnel department and federal/state employment enforcement officers.
Date

MonthDayYear
Date
Age
Sex
Ethnic Group
Document Uploads
Cover Letter

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Letters of Reference

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University Placement File

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Copy of Transcripts

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Copy of Current Certificate

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DD-214

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Other

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Application Acknowledgment
Application Acknowledgment - Signature
Application Acknowledgment - Date

MonthDayYear
Date
Applicant Name

First NameLast Name
Should be Empty:

Poplar School District Certified Application

Employment Eligibility and Certifications

Employment History

Education and Qualifications

References

Background and Additional Disclosures

Authorization to Release Information

Employment Preference Form

AFFIRMATIVE ACTION INFORMATION – OPTIONAL

Document Uploads

Application Acknowledgment