Fill - Free fillable Misc 197128 Standard Application For Employment PDF form

LSMSAApplic ation forEmployment

ApplicantInformation

FullName:

Last First M.I.

OtherNamesUsed:

Address:

StreetAddress Apartment/Unit#

City State ZIPCode

Phone:  EmailAddress:

PositionAppliedfor:

BackgroundInformati on

1. Doyoupossessavaliddriver’slicense?

2. Areyoucurrentlyholdingorrunningforanelectivepublicoffice?

3. Haveyoueverbeenonprobationorsentencedtojailasaresultofbeingconvicted,orpledguiltyto

afelony?

Ifyouanswered“Yes”toQuestion3,listbelowthelawenforcementauthorityinvolved(city,police,

sheriff,FBI,etc.),theoffense,thedateoftheoffense,andtheplaceanddispositionofeachcase.

4. Haveyoueverbeenfiredfromajoborresignedtoavoiddismissal?

Ifyouanswered“Yes”toQuestion4,pleaseexplain.

5. Ifyouareapplyingforapositionthatinvolvesthehandlingofcashorotherfundsorfinancial

informationfortheSchoolorstudents,areyourwagescurrentlybeinggarnished?

6. Ifyouareamalebetweentheagesof18and25,areyouregisteredwiththeSelectiveServiceSystem

orareyouexemptedfromsuchregistration?

7. AreyoulegallyeligibletoworkintheUnitedStates?

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LSMSAStandardApplicationforEmployment∙2

TeachingHistory

Ifapplyingforateachingposition,pleaseprovideahistoryofyourteachingexperience.

Institution Level Years

ConsentandRelease

Pleasereadeachstatementcarefullybeforesigning.

Icertifythatallinformationprovidedinthisemploymentapplicationandallsupplementalmaterialistrueandcomplete.Iunderstand

thatanyfalseinformationoromissionmaydisqualifymefromfurtherconsiderationforemploymentandmayresultinmydismissalif

discoveredatalaterdate.

Iauthorizetheinvestigationofanyorallstatementscontainedinthisapplication.Ialsoauthorize,whetherlistedornot,anyperson,

school,currentemployer,pastemployers,andorganizationstoproviderelevantinformationandopinionsthatmaybeusefulinmaking

ahiringdecision.Ifsuchcurrentorprioremployerisacity,parishorotherlocalpublicschoolboard,Iauthorizethedisclosurebysuch

employer’sinformationofallinstancesofsexualmisconductwithstudentsascommittedbyme,ifany.Ireleasesuchpersonsand

organizationsfromanylegalliabilityinmakingsuchstatementsincludingtheprovidingofanyinformationinvolvingsexualmisconduct

withstudents.

Iunderstand,ifasuccessfulapplicant,Iwillberequiredtosubmittoandpassadrugscreeningexaminationandacriminalbackground

check  that  includes  fingerprinting.  I  hereby  consent  to  the  drug  screen  and  the  criminal  background  check  as  a  condition  of

employment.  If  employed,  I  understand  that  annually  I  will  be  requiredtosubmitafinancialdisclosurestatementandadual

employment  statement.  If my  position might involve or require transportingstudents,driving school‐ownedvehicles,or driving a

personalvehicleforschool‐relatedbusiness,Imustcompleteastate‐sponsoreddrivingexamination(writtentest)everythreeyears.

I understandthatthisapplication,verbalstatementsorsubsequentemploymentdoesnotcreateanexpressorimpliedcontractof

employmentnorprovideforemploymentforanydefiniteperiodoftime.

TermsofAcceptanceandSignat ure

TermsofAcceptance:I,theapplicantforthisStandardApplicationforEmployment,warrantthetruthfulness

oftheinformationprovidedinthisapplication.

Clickheretoindicatethatyouwillsubmitacoverletter,professionalresume,unofficialtranscripts,and

threeprofessionalreferences.

Iunderstandthatcheckingthisboxandtypingmynamebelowconstitutesalegalsignatureconfirmingthat

IacknowledgeandagreetotheaboveTermsofAcceptance.

Electroni cSignatu re

PleasetypeyourFirstNameandLastName

LSMSAiscommittedtoequalemploymentopportunity.TheSchoolwillnotdiscriminateagainstnortoleratediscriminationagainstany

employeeorapplicantforemploymentonanylegallyrecognizedbasisincluding,butnotlimitedto:race,color,creed,disability,

religion,sex,sexualorientation,genderidentity,nationalorigin,politicalaffiliation,disability,citizenship,orage.Thispolicyappliesto

allpersonnelactionincludingrecruitment,hiring,training,promotions,compensation,benefits,transfers,layoffs,termination,

recreationalandsocialprograms,andprofessionalcontracts.

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Misc 197128 Standard Application For Employment

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