ࡱ> XZW ^bjbjqq ATeeg++   8WL ??UUU<<<  "%  |< ++UUk    d+U U     @ Up(2  0  %&%& %&  p< |*<<< |<<< %&<<<<<<<<< : Southern Tioga School District Boyanowski Administration Building 241 Main Street, Blossburg, PA 16912-1155 (570) 638-2183 Support Staff Employment Application Form Updated August 2007 DATE: Position for which you are applying: NAME: Social Security #: Last First Middle Address: Street City State Zip Home Telephone: ( ) Daytime Telephone:( ) County EDUCATION:  SCHOOL ADDRESS DATES ATTENDED DEGREE/CERTIFICATE Secondary  College Other Are you over 18 years of age? yes no If not, employment is subject to verification of minimum legal age. If you are presently employed, please state reason(s) a new position is being sought: When will you be available to begin work? Will you work overtime if asked? yes no What is the minimum salary/wage that is acceptable to you? $ Special Training/Skills: Summarize special job-related skills and qualifications acquired from employment or other experiences. Also state any additional information you feel may be helpful in considering your application, i.e. honors, awards, activities, technology skills, or special training. The Southern Tioga School District is an equal opportunity employer in compliance with Title IX, Title VI, and Act 504. EMPLOYMENT HISTORY: (include military service, if any)     We may contact your former employers unless you specifically request in writing to not contact a former employer. REFERENCES: NAME ADDRESS TELEPHONE RELATIONSHIP TO YOU     GENERAL BACKGROUND INFORMATION You must give complete answers to all questions. If you answer Yes to any question, you must list all offenses, and for each conviction provide the date of conviction and disposition, regardless of the date or location of occurrence. Conviction of a criminal offense is not a bar to employment in all cases. Each case is considered on its merits. Your answers will be verified with appropriate police records. Criminal Offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of nolo contendere (no contest). Conviction is an adjudication of guilt and includes determinations before a court, a district justice or a magistrate, which results in a fine, sentence or probation. You may omit: minor traffic violations, offenses committed before your 18th birthday which were adjudicated in a juvenile court or under a Youth Offender Law, and any convictions which have been expunged by a court or for which you successfully completed an Accelerated Rehabilitative Disposition program. Were you ever convicted of a criminal offense? ( Yes ( No Are you currently under charges for a criminal offense? ( Yes ( No Have you ever forfeited bond or collateral in connection with a criminal offense? ( Yes ( No Within the last ten (10) years, have you been fired from any job for any reason? ( Yes ( No Within the last ten (10) years, have you quit a job after being notified that you would be fired? ( Yes ( No Are you subject to any visa or immigration status, which would prevent lawful employment? ( Yes ( No NOTE: If you answered yes to any of the above questions, please provide a detailed explanation on a separate sheet of paper, including dates, and attach it to this application. Please print and sign your name on the sheet and include your social security number. 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