ࡱ> GIF` 'bjbj h:$>>>>R4Nmmm$hlmmuuu"uuuu >6u 0NuuuLmZ@u4;Vmmmk mmmND>> MILLINOCKET SCHOOL DEPARTMENT P.O. Box 30 Millinocket, Maine 04462 (207) 723-6400 (207) 447-6599 - Fax APPLICATION FOR NON-TEACHING POSITION THE MILLINOCKET SCHOOL DEPARTMENT DOES NOT DISCRIMINATE IN THE OPERATION OF ITS EDUCATIONAL AND EMPLOYMENT POLICIES AND WILL HONOR ALL APPROPRIATE LAWS RELATIVE TO DISCRIMINATION. Date ________________________________ Position Applying for: Name _______________________________ _________________________________________________ (Custodian, Secretary, Educational Technician, Cafeteria Worker, etc.) When will you be available? ________________ Email Address: ____________________________________ Permanent Address ___________________________________________ ____________________________________________ Telephone Number (s)_________________ EDUCATION: Starting with high school, list any schools or colleges you may have attended. No. of Yrs. School Attended Address Attended Graduated/Degree ________________________ ________________________ ___________ ________________ ________________________ ________________________ ___________ ________________ ________________________ ________________________ ___________ ________________ ________________________ ________________________ ___________ ________________ SPECIAL SKILLS: To be completed by clerical applicants: Typing _____ Yes _____ No WPM ______ Shorthand _____ Yes _____ No WPM ______ What office machines are you familiar with?______________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ What other special skills do you have or licenses do you hold that may be relevant to this position?__________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ EXPERIENCE: Please list all previous employment starting with the most recent job held. Use another page if necessary. Please account for any gaps in employment during the past ten years on another page. From To Position Duties Employer (month/year) ____ to ____ _______________________ _________________________ __________________________ ____ to ____ _______________________ _________________________ __________________________ ____ to ____ _______________________ _________________________ __________________________ ____ to ____ _______________________ _________________________ __________________________ ____ to ____ _______________________ __________________________ __________________________ 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 you or your conduct was under investigation or review? Yes ___ No ___ Has your contract in a prior position ever been non-renewed? Yes ___ No ___ 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 (other than a minor traffic offense)? Yes ___ No ___ 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 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)? Yes ___ No ___ 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. Use additional sheets if necessary. Conviction or other disposition of a crime is not necessarily an automatic bar to employment. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ REFERENCES: List three, two of whom are most recent supervisors, who can comment on your ability and whom we may contact. Name Position Address Phone  __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 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 Millinocket School Department contacts in connection with my employment application to fully provide the Millinocket 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 Millinocket 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 board members, administrators, other staff, and members of the community. I give my consent to this disclosure. _______________________________________________ Signature/Date __________________________________________________________________________________________________ APPLICATION FOR NON-TEACHING PERSONNEL CHECK LIST: The completed employment application can not be evaluated unless all of the following materials have been provided. _____ Application form fully completed _____ 3 Letters of recommendation _____ Resume _____ Transcripts _____ Relevant certification _____ Gaps in employment during the past ten years explained _____ YES to any of the questions in the Background section explained _____ Application signed __________________________________________________________________________________________________ NOTE: ALL APPLICATION MATERIALS BECOME THE PROPERTY OF THE MILLINOCKET 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. 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B2MILLINOCKET SCHOOL DEPARTMENTSuperintendent's OfficeAuthorized UserOh+'0<L dp     MILLINOCKET SCHOOL DEPARTMENTSuperintendent's Office4Application for Non-teaching position - Rev. 8/9/96NormalAuthorized User8Microsoft Office Word@F#@PP,@H<>p@8՜.+,0 hp  Millinocket School Dept.9 MILLINOCKET SCHOOL DEPARTMENT Title  !"#$%'()*+,-./012345789:;<=?@ABCDEHRoot Entry F JData 1Table&WordDocumenth:SummaryInformation(6DocumentSummaryInformation8>CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q