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PERRY COUNTY BOARD OF EDUCATION

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PERRY COUNTY BOARD OF EDUCATION Powered By Docstoc
					                        PERRY COUNTY BOARD OF EDUCATION
                                        “We Put Kids First”
                                           315 Park Avenue
                                           Hazard, KY 41701
                                             606-439-5813



                 Classified Application for Employment
                    **For this type of employment, State Law requires a criminal
                         background check as a condition of employment**


Check position(s) applied for:

                      Cook Baker                              Clerk
                      Custodian/Maintenance                   Bus Monitor
                      Paraeducator/Aide                       Secretary


Seeking:              Full time employment                    Part time employment


School Preference:

__________________________________________


____________________________




Personal Information


 Name:
                        Last                        First                      Middle


 Address
                               Street                         City          State       Zip Code


 Telephone #                                          Social Security #

 Date Of Birth
 Education (years completed/highest degree earned
 Have you filed an application with Perry County Board of Education before?
 If yes, give Type and Date
Employment Background

Last Employer:
  Name                                             Phone #

References:

    Name                                       Name
  Address                                    Address
  Phone #                                    Phone #



Job Specific Experience

List any job related experience you have for the position for which you are
applying:



Will you abide by all rules, laws, regulations and requirements of the position for
which you are applying?




Upon hire, you must complete all pre-employment requirements (job-
specific testing, background check, physical and TB skin test, proof of high
school graduation or GED, submit to and pass a drug screen, complete an
I-9 form—requiring copies of documents such as your drivers license and
social security card— , and/or other job-related requirements.)

I understand and will comply with the above stated requirements prior to
employment by the Perry County Schools.


Signature of Applicant ___________________________ Date ______________

                    PLEASE PRINT AND RETURN SIGNED APPLICATION TO:
                           Rosita Combs, Human Resources Director
                           Perry County Board of Education
                           315 Park Avenue
                           Hazard, KY 41701

                            Title IX Requirements
                 Perry County Schools does not discriminate on the basis
                   of race, color, national origin, sex, age or disability.

				
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