JEFFERSON-SCRANTON COMMUNITY SCHOOL
Classified Employment Application

POSITION DESIRED
Departments
Food Service  
Teacher Aide
Maintenance  
Transportation
Secretarial/Clerical  
Other:
 
Date of Application: , 20  
Telephone (home)
   
(work)
Last Name: First Name: Middle Name:
Street Address: City: State: Zip:
Military Service? Dates of Service: Type of Discharge:
Social Security Number:
SECRETARIAL, CLERICAL AND AIDE APPLICANTS ONLY
Business Machines and Computers Familiar With:
BUS DRIVER APPLICANTS ONLY
Have you ever had your driver's license suspended or revoked? Yes: No:
If yes, explain:
List traffic violations other than parking violations (within the last five years):
Moral turpitude is an act of baseness, vileness, or depravity in the private and social duties which a person owes another member of society or society in general and which is contrary to the accepted rule of right and duty between persons, including but not limited to theft, attempted theft, murder, rape, swindling and indecency with a minor. Have you ever been convicted of a felony or any offense involving moral turpitude?
  Yes: No:
 
EDUCATION/TRAINING
List any education which you feel will help you do the job for which you have applied:
School
Location
Dates
Graduation
Yes/No/Date
Diploma/Certificate
Degree Earned
         
         
         
 
WORK EXPERIENCE
Employer, Address, Supervisor
Phone
Dates
From/To
Position
Held
Salary
Reason for
Leaving
           
           
           
 
EMPLOYMENT REFERENCES
Name
Occupation
Complete Address
Day Phone
       
       
       
 
If my duties will include driving a school vehicle for which I need a CDL license and if the vehicle transports 16 or more persons or the vehicle weighs 26,001 pounds or more, I have been informed of the requirement to submit to a drug test prior to being employed by the District to perform a safety-sensitive function. I consent to submit it to the District’s drug and alcohol testing program. I also understand that if I have a positive drug test, I will not be considered further for employment by the District.
 
Misrepresentation or willful omissions may be sufficient cause for disqualification of this application or termination of employment. I hereby authorize Jefferson-Scranton Community School to conduct work history, personal reference or police record inquiries to determine my acceptability for employment.
 
Return to: Superintendent
Signature
   Jefferson-Scranton Community School
204 W. Madison
Jefferson, IA 50129-2129
 
Jefferson-Scranton Community School District does not discriminate based on gender, race, national origin, creed, age, marital status, sexual orientation or disability. Inquiries and grievances may be directed to the Affirmative Action Coordinator, Jefferson-Scranton Community School, Jefferson, IA 50129-2129, (515)386-4168, or to the Director of the Region VII Office of Civil Rights, Department of Education, Kansas City, MO.