Application for Non-Certified Position

M.S.D. of Warren County

101 North Monroe Street, Box 207

Williamsport, Indiana 47993

The Metropolitan School District of Warren County, Indiana does not discriminate in hiring or employment on the basis of race, color, sex, age, disability, religion, or national origin.

Please enter all applicable information in the application. Additional information can be submitted as needed.

If you are applying for a bus driver position, do you have a CDL?

Yes

Will you accept?*

Part Time

Full Time

Night Shifts

Name*

Address*

Phone*

Date of Birth*

Email: Must use a Gmail account.*

Have you ever been previously employed by this corporation?*

Yes

If yes, when and in what position.

What was your reason for leaving?

Are there any physical limitations which may influence performance of your duties?*

Social Security Number

(Completion of social security is optional. Failure to submit social security number will not prohibit employment consideration. Your social security number will be required on various other employment documents.)

CURRENT EMPLOYMENT INFORMATION

Name of Employer*

Address

Length of present employment

Present Salary or Hourly Rate?*

Date available to begin new position*

Present Position*

Days absent from work during the past year?*

EDUCATION

(Undergraduate or Graduate)

High School Attended*

Graduation Date (If a diploma was received.)*

Other Training

College/University Attended:

Graduation Date/Degree (If a diploma was received.)

Military Experience

EMPLOYMENT HISTORY

For each employer, list the name, dates employed, job description, reason for leaving and supervisor's contact information.

Employer 1 (Most recent or current employer)*

Employer 2

Employer 3

REFERENCES

(List three persons who know your professional background and qualifications. Do not list relatives.)

List their name, address and phone number.

Reference 1*

Reference 2*

Reference 3*

ADDITIONAL BACKGROUND INFORMATION

1. Is your conduct as an employee or the quality of your work the focus of any investigation by your current employer?*

Yes

2. Have you ever been reprimanded, disciplined, discharged, or asked to resign from a previous position?*

Yes

3. Have you ever resigned from a position after being offered the opportunity to resign rather than be terminated?*

Yes

4. Have you ever resigned from a prior position without being asked; but under circumstances involving your employer's investigation of sexual conduct with another person, mishandling of funds, or criminal conduct?*

Yes

5. Have you ever been investigated for. charged with, or pled guilty or "no contest" to any crime involving sexual abuse of any person or indecency with a minor?*

Yes

6. Have you ever pled guilty, been convicted of, or otherwise been found in violation of the law by a court for any matter other than a minor traffic violation?*

Yes

7. Have you ever been charged with a crime, other than minor traffic offense, where the court has deferred further proceedings, without entering a finding of guilt and placed you on probation or in a public service or education program?*

Yes

Describe the talents, skills, and special qualifications you possess that will make you a successful member of the M.S.D. of Warren County family.*

WAIVER

PUBLIC LAW 93-389 "Family Educational Rights and Privacy Act of 1974"

I hereby certify that the information found within this application has been provided voluntarily and I waive any right to assert discrimination on the basis of that which has been divulged.

I hereby authorize all persons, firms, corporations, educational institutions, and organizations of any kind to release to the M.S.D. of Warren County any and all information, files, or records pertaining to this application, and to permit inspection, and to furnish copies of any documents pertinent to this application. I further authorize any and all persons in any capacity to answer any and all questions in any form that may be submitted to them concerning this application.

In the event of employment, I understand that false, misleading or omission of information given in my application or interview(s) may result in discharge.

I expressly waive in connection with any request for, or provision of such information any claims or accuses of action including, without limitation, defamation, infliction or emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the school district, its officials, employees, trustees or agents, or against any provider of any information.

I have read this authorization an release of all claims, and I expressly agree to the terms set out herein.

The information submitted on this application is accurate to the best of my knowledge. I understand that my application will be retained in current files for a period of one year.

By clicking 'Submit', I am officially signing my name to the information and documents that I have submitted.*

I agree.