Lamar County Child Nutrition

Last Name: First Name: MI/Maiden:

Current Address:

Contact Number:

Alternate Number:

SSN:

DOB (optional):

Check all positions for which you are applying and/or you are qualified:

Bus Driver	Bus Mechanic
Janitorial/Custodial	School Police Officer
Cafeteria Manager	Clerical (School Level)
Cafeteria Worker	Assistant Teacher/Paraprofessional
Maintenance Worker	Other (specify)
School Preference:

Educational Background Information

Name and Address of High School Attended:

Name and Address of College or Business School Attended:

Degrees or Certifications Recieved with Date:

Employment/Experience

List at least threee (3) previous employers starting with the most recent who can attest to your personal character and work performance/experience.

From: To: Employer:

Address:

Supervisor:

Phone:

Job Title :

Co-worker:

Duties:

Reason for Leaving:

From: To: Employer:

Address:

Supervisor:

Phone:

Job Title :

Co-worker:

Duties:

Reason for Leaving:

From: To: Employer:

Address:

Supervisor:

Phone:

Job Title :

Co-worker:

Duties:

Reason for Leaving:

Please indicate if you are fearful that your present job would be in jeopardy if inquiries are made: Yes No

When are you available for an interview?

References

List at least two (2) references who can attest to your moral/personal character and coment on your abilities? You are welcome to mail additional pages to us regarding your application (e.g biological, summary, letters of references, etc.)

Name: Phone:

Respond to the following:

Yes No

Have you ever been charged or indicted for a felony?

Yes No

Have you ever been officially terminated from employment with any school district?

Yes No

Have you ever resigned from a position at a time when proceedings were in process to terminate you?

Yes No

Do you know of any reason why the district should not consider you for employment?

NOTE: The Lamar County School District will conduct background checks and references with rprevious/current employers. Your signatures on this application provides consent for these checks to be made.

For Assistant Teacher Applicants Only

Have you taken the WorkKeys test? If yes, you must mail us a copy of your scores. Also, to be employed as an assitant teacher, you must have a high school diploma or its equivalent.

Please also mail a copy of your diploma or GED certificate. If you have at least 48 hours of college coursework, you are not required to take the WorkKeys test but must furnish an official transcipt verifiying the hours.

Statement and Signature

I, the undersigned applicant, pledge that the above information is true and correct tot he best of my knowledge.

Signed:

Date:

Employment Application