ࡱ> ILH_ bjbj 0,h1bh1b      4444Dx4,^+++++++$-/+ BBB+  +rrrBF  +rB+rro)h* zP)s++0,)l0l0 *l0 *> ,r7$[++,BBBBl0 B : CATASAUQUA AREA SCHOOL DISTRICT  HYPERLINK "http://www.cattysd.org" www.cattysd.org Employment Forms Checklist NAME Phone# ____________ POSITION APPLYING FOR INSTRUCTIONS It is mandatory, by law, that all applicants of the Catasauqua Area School District complete the following forms prior to your being recommended to the Board of Education for employment. Please present this list, along with completed forms to the Administration Office for confirmation. No applicants will be considered for employment unless all forms are complete. Please be sure to retain clearance copies for your records. CHECKLIST _____ Completed application _____ ACT 34 clearance by PA State Police (www.epatch.state.pa.us) _____ PA Child Abuse History Clearance ( HYPERLINK "http://www.compass.state.pa.us/cwis" www.compass.state.pa.us/cwis) _____ FBI Federal Criminal History ( HYPERLINK "https://uenroll.identogo.com" https://uenroll.identogo.com to apply Service Code 1KG6XN) _____ ACT 168 PA Sexual Misconduct/Abuse Disclosure Release (1 for each qualifying employer) _____ ACT 126 Child Abuse Training Requirement ( HYPERLINK "https://www.reportabusepa.pitt.edu/" \t "_blank" https://www.reportabusepa.pitt.edu) _____ Federal Ethnicity and Race Form _____ Disclosure Statement _____ Act 24 Arrest/Conviction Report and certification form 10._____ Completed physical exam / TB Test (Physical must be less than 1 year old. TB test must be less than 3 months old) Not for Custodians separate physical form needed for all custodial candidates _____ Form I-9 Citizenship (NEED COPY OF DRIVERS LICENSE & SS CARD) _____ Professional Certificate (teachers only) PPID # __________________________ _____ Copy of transcripts (teachers only) _____ W-4 tax form _____ Direct Deposit Form required for all employees _____ Market Place Notification 17._____ Local Services Tax CASD Exemption Certificate If income is under $12,000 must go to municipality working in (see  HYPERLINK "http://www.newpa.com" www.newpa.com) 18._____ Local Earned Income Tax Residency Certification Form (fill in top and bottom sections) 19._____ Workers Compensation Insurance Form 20._____ Nepotism Policy 21. _____Copy of Social Security Card if not provided for I9 identification 22._____ Release of drivers record (Form AA-502A) (bus/van drivers Custodian/Maintenance only) 23._____ Transportation Standards/Procedures/Guidelines (Signed) (bus/van drivers only) 24._____ Computer/Internet Form & New Employee Computer Accounts (F/T employees only) 25._____ Computer/Internet Form (substitute teachers only) ****DISTRICT USE ONLY**** INTERVIEWED IF APPLICABLE (SIGN & DATE BY PRINCIPAL) ________ I hereby confirm that the above named applicant has completed all required employment forms as listed. The forms are enclosed herewith. Date of Hire Signature______________________________________ First Day of Work Date Signed____________________________________ NOTE: Must request retirement/sick days from former district, if employee is transferring to CASD. "#GHIXYZz~> C % ( = w xfxVxfxKhv;hv;CJ aJ hhF5CJOJQJaJ"hhnI5>*CJOJQJaJhhnI5CJOJQJaJhWCJaJhrehnI5CJ\aJhrehnI5>*CJaJhre>*CJaJhrehZ5>*CJaJhrehnI>*CJaJhrehnICJaJhnI5CJOJQJ hnI0JjhnIUjhnIUhnIZuz= \ E  W %8hdh^8`hgdz hdh^hgdz & FdhgdT & FdhgdtLYgdW$a$d$a$w x y  < = Y Z [ \ b ĭwl^lwNh-@h230J5OJQJaJh23h235OJQJaJh235OJQJaJjh235OJQJUaJ'ha;0JCJ^JaJfHq #ha;CJ^JaJfHq ,jha;CJU^JaJfHq hrehwRZ5OJQJaJhrehnI5OJQJaJhj5OJQJaJ hnI5hnIhrehv;CJ aJ  % D E K s u v  ̢̾odYK=hrehR5OJQJaJhThT5OJQJaJhR5OJQJaJh55OJQJaJ0hG<0JB*CJ^JaJfHphUq hG<jhG<Uhreh`s5OJQJaJhreh55OJQJaJhrehx5OJQJaJhreh:5OJQJaJhj5OJQJaJh235OJQJaJhrehnI5OJQJaJjh235OJQJUaJ  . 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PL^P`LhH.,?9KVL/izB*Ng2BK                                           ,+t  5:`6$L .23+E4Z5OR:x:a;v;G<g?nICJ[O})O=WtLYwRZ@ cLjiN{zxWrmT3`s.R|)cre}ojF  @ @UnknownG*Ax Times New Roman5Symbol3. *Cx ArialA$BCambria Math"1hբiբi:K K !24   3QHP?6$2!xx CATASAUQUA AREA SCHOOL DISTRICTValued Gateway ClientKristen Bloszinsky      Oh+'0 $0 P \ h t CATASAUQUA AREA SCHOOL DISTRICTValued Gateway ClientNormalKristen Bloszinsky2Microsoft Office Word@@P @8P@8PK ՜.+,D՜.+,T hp   Microsoft   CATASAUQUA AREA SCHOOL DISTRICT Titlex 8@ _PID_HLINKSA0] http://www.newpa.com/nt $https://www.reportabusepa.pitt.edu/@https://uenroll.identogo.com/pg$http://www.compass.state.pa.us/cwisj)http://www.cattysd.org/  !"#$%&'()*+,-./012345679:;<=>?ABCDEFGJKNRoot Entry FPM@Data 1Table0WordDocument 0,SummaryInformation(8DocumentSummaryInformation8@MsoDataStoreПP zPKI1AQQQ==2ПP zPItem  PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q