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JOB APPLICATION 912 W. 6th Ave. Pine Bluff,

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912 W. 6th Ave.
Pine Bluff, AR 71601 870.534.6129
www.aresc.k12.ar.us
JOB APPLICATION
Name:
Date:
Position Desired:
Date Available for Work:
I authorize investigation of all statements contained in this application. I understand
misrepresentation or omission of facts called for is cause for dismissal without notice at
any time during my employment.
I agree, if employed, to follow all rules and regulations of this cooperative.
I understand that if offered employment it will be contingent on successfully passing a
background check which will include the Child Maltreatment registry. I also agree that I
will assume all expenses associated with conducting the background check.
I agree to promptly notify the cooperative of any change of address during my
employment.
Date:
Signature:
The Arkansas River Education Service Cooperative is an equal opportunity educational and
employment institution. The law protects the rights of an equal employment opportunity
regardless of race, religious creed, national origin, ancestry, physical handicap, sex, or age.
Please submit resume and three letters of reference along with the
completed application to ARESC-Human Resources 912 W. 6th
Avenue, Pine Bluff, AR 71601
click to sign
signature
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Arkansas River Education Service Cooperative
912 W. 6th Avenue, Pine Bluff, AR 71601
Cell:
City/State/Zip
Home Phone:
Social Security No:
Location/Dept:
Referred by
In case of eme
rgency,notify:
S
treet Address:
Have you ever been convicted of a crime other than a traffic violaton?
Yes
No
Name:
Last
Street Address:
Email:
Date of Birth:
First Middle
Yes
No
If yes, explain:
Are you currently on the
child maltreatment registry?
Can you lift 25 lbs. or more?
Yes
No
Due to the roles and responsibilities of most positions at ARESC, reliable transportation and a
current driver's license is necessary for employment and valid insurance coverage
documentation may be requested.
Yes
No
No
Relationship
Do you have reliable transportation with valid insurance coverage?
Do you have a current/valid Driver's License?
Driver's License #:
Issuing State
References:
Address Telephone
Month Day Year
Are you a U.S. Citizen?
If not, are you a legal Alien?
Have you ever been employed at ARESC?
When?
Name of relatives or friends working here:
Relationship
Relationship
City/State/Zip
Name Relationship
Yes
Education
High School
Name of Institution City/State/Zip Dates Attended:
(XX/Year – XX/Year)
Diploma or Grades Attended
College or University
Name of Institution –
City/State
Dates Attended:
(Month/Year –
Month/Year)
Degree or Total
Semester Hours Earned
Major/Minor
Graduate Work
Name of Institution –
City/State
Dates Attended:
(Month/Year –
Month/Year)
Degree or Total
Semester Hours Earned
Major/Minor
OPTIONAL: If you are a recent College graduate with limited experience, list leadership opportunities and
other pertinent activities in which you have participated along with any special interests:
COMPLETE ONLY IF APPLYING FOR A POSITION REQUIRING LICENSING CREDENTIALS.
Provisional
Provisional
Do you hold a Teacher/Administrator’s License? Yes No If yes, is it
State of License Expiration Date:
List area(s) of licensure:
Do you hold another license/certification?
Yes
No If yes, is it
State
of License Expiration Date:
List area(s) of licensure:
Dates:
From/To
Job Title/Function Name of Organization
Telephone
Number
Supervisor’s
Name/Position
List salary of last position held: $
If you are a retired educator, what was the separation date from your last education job?
Non-Teaching Experience (If applicable)
Dates:
From/To
Job Title/Function Name of Organization Telephone
Number
Supervisor’s
Name/Position
Standard
Standard
BE SURE TO ATTATCH LICENSE/CERTIFICATE AND COMPLETE THIS PAGE.
Teaching/Administration Experience: (Attach additional pages if necessary)
COMPLETE ONLY IF APPLYING FOR A POSITION THAT DOES NOT REQUIRE LICENSE OR CERTIFICATION.
Work Experience: (Attach additional pages if necessary)
Dates:
From/To
Job Title/Function
Name of Organization Telephone
Number
Supervisor’s
Name/Position
List salary of last position held: $
OPTIONAL: If you are a recent College graduate with limited experience, list leadership opportunities and
other pertinent activities in which you have participated along with any special interests:
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JOB APPLICATION 912 W. 6th Ave. Pine Bluff,

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Completed 22 July 2021

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