Docstoc

Rogers Communications Employment Application

Document Sample
Rogers Communications Employment Application Powered By Docstoc
					                                           KITTERY SCHOOL DEPARTMENT
                                         200 Rogers Road, Kittery, ME 03904-1458
                                                      207-475-1334

                              APPLICATION for MAINTENANCE DIRECTOR
                                       PLEASE PRINT or TYPE


                              The Kittery School Department is an Equal Opportunity Employer.

============================================================================================
PERSONAL DATA:

_______________________________________________________________________________________________________
       Last Name                                  First                        Middle

_______________________________________________________________________________________________________
       Today’s Date                                       Social Security Number

_______________________________________________________________________________________________________
       Street Address

_______________________________________________________________________________________________________
       City                                       State                        Zip Code

_______________________________________________________________________________________________________
       Home Phone Number                          Office Phone Number          Cell Phone Number

_______________________________________________________________________________________________________
       Email Address

        If employed, can you offer proof of U.S. citizenship:           ____ Yes          ____No

        I may be contacted:                                             ____ At Work      ____At Home


                Please complete all information in the application even though it may be duplicated on your resume.



Send ALL information To:           Larry Littlefield, Superintendent of Schools, 200 Rogers Road, Kittery, Maine 03904

PLEASE NOTE:                       On the completion of the search, all application materials received will be on file for three years.

                                     APPLICATION DEADLINE: June 10, 2011




CURRENT EMPLOYMENT INFORMATION

Are you presently under contract:                    □Yes       □No

If Yes, when does your contract expire?______________________________________________________________

Name of Employer:______________________________________________________________________________

Position:__________________________________________________________Present Salary:________________
                  Name/Location of School      Course of Study        No. of Years Completed   Did you Graduate?   Degree or Diploma
                                                                                               and Date
Graduate School




College




Business/Trade/
Technical




WHAT LICENSES or CERTIFICATIONS DO YOU CURRENTLY HOLD THAT ARE RELEVANT TO THIS
POSITION? List any other relevant special skills.

Licenses/Certifications                                                                         Expiration Date




Other relevant special skills - please list




DO YOU HOLD A VALID MAINE DRIVER’S LICENSE?                    □Yes               □No
If yes, what class?__________________________________________________________________________________
What endorsement:________________________________________________________________________________

FINGERPRINTING and BACKGROUND CHECK: Fingerprinting must be done by the Maine State Police and a
copy of the Criminal History Record Check certificate needs to be submitted to Central Office within one month after hire
date.

     Have you been fingerprinted in Maine?      □Yes      □No

     If yes, when and where?__________________________________________________________________________


WHEN WILL YOU BE AVAILABLE TO START THIS JOB?_________________________________________
EXPERIENCE:                Please account for any gaps in employment on a separate page.

______________________________________________________________________________________________________________________
EMPLOYER

______________________________________________________________________________________________________________________
ADDRESS

______________________________________________________________________________________________________________________
JOB TITLE

______________________________________________________________________________________________________________________
NAME OF SUPERVISOR                                                          TELEPHONE NUMBER

______________________________________________________________________________________________________________________
EMPLOYED (State Month and Year): FROM                                       TO

______________________________________________________________________________________________________________________
REASON FOR LEAVING
=========================================================================================================

______________________________________________________________________________________________________________________
EMPLOYER

______________________________________________________________________________________________________________________
ADDRESS

______________________________________________________________________________________________________________________
JOB TITLE

______________________________________________________________________________________________________________________
NAME OF SUPERVISOR                                                      TELEPHONE NUMBER

______________________________________________________________________________________________________________________
EMPLOYED (State Month and Year): FROM                                   TO

______________________________________________________________________________________________________________________
REASON FOR LEAVING
=========================================================================================================

______________________________________________________________________________________________________________________
EMPLOYER

______________________________________________________________________________________________________________________
ADDRESS

______________________________________________________________________________________________________________________
JOB TITLE

______________________________________________________________________________________________________________________
NAME OF SUPERVISOR                                                      TELEPHONE NUMBER

______________________________________________________________________________________________________________________
EMPLOYED (State Month and Year): FROM                                   TO

______________________________________________________________________________________________________________________
REASON FOR LEAVING

REFERENCES: LIST THREE MOST RECENT SUPERVISORS, WHO CAN COMMENT ON YOUR ABILITY AND
WHOM WE MAY CONTACT. IN ADDITION, PLEASE PROVIDE THREE LETTERS OF PROFESSIONAL
REFERENCE FROM PERSONS WHO ARE NOT RELATED TO YOU (MAY BE FROM REFERENCES LISTED
BELOW).


____________________________________________________________________________________________________________________________________
NAME                                                                                 POSITION

____________________________________________________________________________________________________________________________________
ADDRESS
____________________________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________________________
TELEPHONE NUMBER

======================================================================================================================



____________________________________________________________________________________________________________________________________
NAME                                                                                 POSITION

____________________________________________________________________________________________________________________________________
ADDRESS

____________________________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________________________
TELEPHONE NUMBER

======================================================================================================================



____________________________________________________________________________________________________________________________________
NAME                                                                                 POSITION

____________________________________________________________________________________________________________________________________
ADDRESS

____________________________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________________________
TELEPHONE NUMBER


======================================================================================================================


BACKGROUND:

Have you ever been disciplined, discharged, or asked to resign from a prior position?                                 Yes___ No___

Have you ever resigned from a prior position after a complaint had been received against                              Yes___ No___
you or your conduct was under investigation or review?

Has your contract employment in a prior position ever been non-renewed?                                               Yes___ No___

Have you ever NOT been nominated for re-employment in a prior position or ever had your                               Yes___ No___
nomination for re-employment not be approved?

Have you ever been charged with or investigated for sexual abuse or harassment of another person?                     Yes___ No___

Have you ever been convicted of a crime (other than a minor traffic offense)?                                         Yes___ No___

Have you ever entered a plea of guilty or “no contest” (nolo contendere) to any crime                                 Yes___ No___
(other than a minor traffic offense)?

Have you ever had a professional license or certificate suspended or revoked in any state, or have you ever
voluntarily surrendered, temporarily or permanently, a professional license or certificate in any state?              Yes___ No___

Has any court ever deferred, filed or dismissed proceedings without a finding of guilty and required that you         Yes___ No___
pay a fine, penalty or court costs and/or imposed a requirement as to your behavior or conduct for a period
of time in connection with any crime (other than a minor traffic offense)?

If you have answered YES to any of the previous questions, provide full details below including, with respect to court actions, the
date, offense in question, and the address of the court involved. Attach additional sheets if necessary. Conviction or other disposition
of a crime is not necessarily an automatic bar to employment.
NOTE: Conviction of a crime is not an automatic bar to employment by the school department.

PLEASE ATTACH:                    1.          RESUME
                                  2.          THREE RECENT PROFESSIONAL LETTERS OF REFERENCE
                                  3.          COPY OF LICENSES/CERTIFICATES
                                  4.          TRANSCRIPTS, IF APPLICABLE

Any willful falsification of information or misleading information on this application or employment screening process shall be
fully sufficient grounds to refuse to employ the applicant or, if the applicant has been employed, shall be immediate cause for
dismissal.

My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest
and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or
federal agency. I further authorize those persons, agencies or entities that the Kittery School Department contacts in
connection with my employment application to fully provide the Kittery School Department any information on the matters
set forth above. I 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 relations that I might
otherwise have against the Kittery School Department, its agents and officials or against any provider of such information.


I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing
committee, which may include school committee members, administrators, other staff, and members of the community. I give
my consent to this disclosure.


                       ______________________________________________________________________________
                                     PRINT NAME

                       ______________________________________________________________________________
                                     SIGNATURE                               DATE


NOTE: All materials become the property of the Kittery School Department. None will be returned.
Providing any false or misleading information on this application or in the application or employment
screening process shall be fully sufficient grounds to refuse to employ the applicant or, if the applicant
has been employed, to immediately dismiss the applicant/employee.

CHECK LIST:      The completed employment application cannot be evaluated unless all of the following materials
have been provided:

           _____       Application form fully completed/signed and dated
           _____       Copies of Transcripts(s), if applicable
           _____       Copy of Licenses/Certificates
           _____       Resume
           _____       Three letters of professional reference
           _____       Gaps in employment during the past ten years explained
           _____       YES to any of the questions in the Background section EXPLAINED

==============================================================================================

The Committee is committed to the principle of Affirmative Action and does not discriminate in the educational and employment programs, that it operates and will
honor all appropriate laws relating to discrimination. There shall be no discriminating in educational programs, activities or employment practices on the basis of race,
national origin, religion, age, gender, sexual orientation or disability under the provisions of Title 5 MRSA Sections 781 et seq.; 4551 et seq. and 4571 et seq., Titles VI
and IX of the 1972 Educational Amendments; Section 504 of the Rehabilitation Act; the Individuals with Disability Education Act, (IDEA) of 1990; Americans with
Disabilities Act of 1990, Title VII (42 USC § 2000c-2; 29 CFR § 1604.11), Age Discrimination in Employment Act (29 USC § 623), 5 MRSA § 4602; 4681 et seq., 20
MRSA § 6553, 26 MRSA § 806-807. (Policy AC - Nondiscrimination/Equal Opportunity)


                                       Thank you for your interest in the Kittery School Department.
Revised:         March 2009

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:5
posted:7/22/2011
language:English
pages:5
Description: Rogers Communications Employment Application document sample