Non Certified Application

Southwest Parke Community School Corporation

NON CERTIFIED APPLICATION
Full Name*

First NameMiddle NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address
Phone Number

Area CodePhone Number
Position (s)*

Maintenance/CustodialTeaching AssistantFood ServiceSecretarialBus DriverSubstitute TeacherECA CoachHealth AidePreschool
Estimated Start Date*

MonthDayYear
Are you currently employed?*

YesNo
May we contact your current employer?*

YesNo
Have you previously been employed by Southwest Parke?*

YesNo
EDUCATION
High School Attended*
Graduation Date

MonthDayYear
College/University Attended
Graduation Date

MonthDayYear
Have you completed at least 30 hours of college credit?

YesNo
LICENSURE
Do you currently hold any of the following licenses?*

Valid Indiana Teaching LicenseValid Indiana Substitute Teaching LicenseValid Indiana CDL LicenseValid Indiana School Bus Yellow CardI do not hold any of these licenses
EMPLOYMENT
Current Employer
Dates Employed
Phone Number

Area CodePhone Number
Type of Work Performed
Tools and/or Equipment Used
Reason for Leaving
Previous Employer #1
Dates Employed
Phone Number

Area CodePhone Number
Type of Work Performed
Tools and/or Equipment Used
Reason for Leaving
Previous Employer #2
Dates Employed
Phone Number

Area CodePhone Number
Type of Work Performed
Tools and/or Equipment Used
Reason for Leaving
Military Experience
Branch of Service
Rank
Number of Years of Military Service
Number of Months of Active Service
References

Please do not list relatives
Reference #1 - Name
Phone Number

Area CodePhone Number
Relationship
Reference #2 - Name
Phone Number

Area CodePhone Number
Relationship
Reference #3 - Name
Phone Number

Area CodePhone Number
Relationship
History and Limitations
Are you presently being investigated or under procedure to consider your discharge for misconduct by your present employer or if you offered a resignation to your previous employer?

YesNo
If you answered "Yes", please explain
Have you ever been reprimanded, disciplined, discharged, or asked to resign from a prior position?*

YesNo
If you answered "Yes", please explain
Have you ever resigned from a prior position without being asked, but under circumstances involving your employer's investigation of sexual contact with another person, of mishandling funds, or of criminal conduct?*

YesNo
If you answered "Yes", please explain
Have you ever been charged with or investigated for sexual abuse of another person?*

YesNo
If you answered "Yes", please explain
Moral turpitude is an act of baseness, vileness or depravity in the private and social duties which a person owes another member of society or society in general and which is contrary to the accepted rule of right and duty between persons, including but not limited to theft, attempted theft, murder, rape, swindling, and indecency with a minor. Have you ever been charged with or plead guilty to any of these?*

YesNo
If you answered "Yes", please explain
Have you ever been convicted of a crime, other than a minor traffic offense, or (b) ever entered a plea of guilty or a plea of "no contest", or has any court ever deferred further proceedings without entering a finding of guilty and placed you on probation, for any crime other than a minor traffic offense?*

YesNo
If you answered "Yes", please explain
Conviction of a crime is not an automatic bar to employment. Southwest Parke Community School Corporation will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position for which you are applying.
Attest and Signature
You agree that if you are hired by Southwest Parke Community School Corporation, you will be obligated to provide information for an Expanded Criminal Background Check. You also agree to pay all fees associated with this background check.
I agree*

YesNo
Any false or misleading information in this application shall be fully sufficient grounds to refuse to employ or having been employed, shall be immediate cause for dismissal. By checking "I Agree" below constitutes your signature and gives authorization to check 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. You further authorize those persons, agencies or entities to give Southwest Parke Community School Corporation information regarding any matters set forth above. You expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relationships that you might otherwise have against Southwest Parke Community School Corporation, its agents and officials or against any provider of such information.

You also certify that all statements made hereon are true to the best of your knowledge. You understand that any false statements made on this application may be cause for non employment or immediate dismissal if employed.
I agree*

YesNo
Please Type Your Name*

First NameMiddle NameLast NameSuffix
Date of Application*

MonthDayYear
If you would like to submit a resume or additional documents, please email them to

Jonella McClintock - mcclintockj@swparke.k12.in.us
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