EMPLOYMENT APPLICATION (SUPPORT STAFF) SOUTH FAYETTE TOWNSHIP SCHOOL DISTRICT
3680 Old Oakdale Road McDonald, Pennsylvania 15057
412-221-4542 www.southfayette.org

Name: ________________________________________________________ Date: ___________________________

Address: _______________________________________________________________________________________ Street Number	Street

Address: _______________________________________________________________________________________ City	State	Zip Code

Phone Number (H) ( 	)	-	 E-Mail Address: ___________________________________

Phone Number (W)( 	)	-___________ Cell Phone Number: (______) ________-______________

How should we contact you (check all that apply)?

 Home Phone

 Work Phone

 E- Mail

Position(s) for which you are applying (check all that are applicable):

 Food Service Employee  Custodian  Maintenance  Paraeducator (teacher’s aide)  Bus Mechanic  Student Monitor  Secretary (Admin. Assist.)  Receptionist  Technology Assistant  Bus Driver  Other- Please explain ________________________________________________
Are you willing to be a substitute for the positions checked above?  Yes	 No

Comments/Clarification etc.:

OFFICE USE ONLY

Date Received: _________	By:__________________ Notes:	_______________________

Revised 8/1/06

CERTIFICATIONS:	Please list below any special certifications that you hold that are related to the position for which you are applying.

Name of Certification
	
Description (what this permits you to do)

		

WORK EXPERIENCE (List most recent first)

			
	Name of Employer
	Dates Employed

(From/To)
	Your Title
	Reason for Leaving
	Final Year Salary
	Name and Title of Supervisor/Phone

								

								

EDUCATION

School and Location
	
Date
	
Degree or Years Attended

			

REFERENCES

Name
	
Address
	
Position
	
Phone Number

				

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 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 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 years, have you been fired from any job for any reason? _____Yes	_____No

Within the last ten 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.

CERTIFICATION AND RELEASE AUTHORIZATION

I certify that all of the statements made by me are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I understand that any misrepresentation of information shall be sufficient cause for (1) rejecting my candidacy, (2) withdrawing of any offer of employment, or (3) terminating my employment.

I hereby authorize any and all of my previous employers and/or supervisors to release any and all of my personnel records and to respond fully and completely to all questions that official of the South Fayette Township School District may ask regarding my prior work history and performance. I will hold such previous employers and/or supervisors harmless of any and all claims that I might otherwise have against them with regard to statements made to this school district. I further authorize these officials to investigate my background, now or in the future, to verify the information provided and release from liability all persons and/or entities supplying information regarding my background. However, I do not authorize the production of medical records or other information, which would tend to actually identify a disability nor do I authorize inquires which would include information related to any medical condition or medical history. Further, I do not waive any rights which I may have under state or federal law related to my right to challenge the disclosure of unlawful or inaccurate information, whether by the school district or by entities or persons providing such information to the school district, including any and all claims concerning allegations of employment discrimination because of race, color, sex, religion, national origin, ancestry, age or disability.

Signature of Candidate 	                                         Date: ______________

South Fayette Township School District does not discriminate in their educational programs, activities or employment practices based on race, color, national origin, sex, disability, age, religion, ancestry or any other legally protected classification. This policy is in accordance with state and federal laws, including Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, the Americans with Disabilities Act of 1990 and the Pennsylvania Human Relations Act. Information relative to special accommodation, grievance procedure, for compliance with Title VI, Title IX and Section 504 may be obtained from Director of Pupil Personnel, South Fayette School District Compliance Officer.