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.