APPLICATION FOR PARA-PROFESSIONAL EMPLOYMENT

Applicant First Name Middle Name Last Name Present Address Street/PO Box City State Zip Other Contact Information Preferred Phone Alternate Phone Email Have you ever been convicted of a felony or misdemeanor other than a minor traffic offense?     Yes     No If yes, please explain: Do you have the results of a current Tuberculin (TB) skin test?     Yes     No Are you certified to drive a S.C. Public School Bus?     Yes     No Education: High school and beyond Name of School City/State Start Date End Date Degree Major Work History From/To Employer City State Type of Work Reason for Leaving List any additional child/school-related work or volunteer experience: Have you ever been dismissed, asked to resign or refused employment?     Yes     No If yes, please explain: May we contact your former employers?     Yes     No May we contact your present employer?     Yes     No If not, please explain: References Provide information for three persons (not relatives or employers) with whom you've had considerable contact: Ref 1 Name Street City State & Zip Email:       Phone: Ref 2 Name Street City State & Zip Email:       Phone: Ref 3 Name Street City State & Zip Email:       Phone: Use the space below to explain how employing you would benefit the Latta School District. If you are offered a position, how soon could you start? READ CAREFULLY BEFORE SIGNING and SUBMITTING I voluntarily give the Latta School District the right to investigate my past employment and activities, agree to cooperate in such investigations, and release from all liability or responsibility all persons, companies, or corporations supplying such information. I fully understand that all false answers or omissions made by me on this application or in connection with the above mentioned investigation will be sufficient cause for my immediate termination. SIGNATURE:       DATE: Latta School District does not discriminate in the employment of staff based on sex, race, age, or handicapping conditions. The district complies with the requirements of Title IX of the 1972 Education Ammendment, Section 504 of the Rehabilitation Act of 1973, and Title VI of the Civil Rights Act of 1964 as well as other applicable civil rights laws. This is OPTIONAL information that we keep because of certain state and federal regulations. If you chose not to provide this information here, you MUST mail or email this information to us, or bring it by our office in person. Date of Birth (Month / Day / Year): Social Security Number: You are not required to disclose information about physical or mental limitations that you believe will not interfere with your ability to do the job. On the other hand, if you want the employer to consider special arrangements to accommodate a physical or mental impairment, you may identify that impairment in the space below and suggest the kind of accommodation you believe would be appropriate. PLEASE PRINT THIS DOCUMENT BEFORE YOU HIT THE SUBMIT BUTTON. You will not be able to make corrections or changes to this document once you click submit.