Grant County ESD

                835 S. Canyon Blvd.

                John Day, OR 97845

                541-575-1349                                            

EMPLOYMENT APPLICATION

Applicant Information

Last Name

 

First

 

M.I.

Date

 

Present Mailing Address

 

Apartment/Unit #

 

City

 

State

 

ZIP

 

Street Address:

 

Apartment/Unit #

 

City

 

State

 

ZIP

 

Phone

 

E-mail Address

 

Date Available

 

Social Security Last 4#.

 

Desired Salary

 

Position Applied for

 

Do you hold a valid Oregon Educational license?

License in other states?

Type of Oregon License

Expiration Date:                                                                          Please attach copy.

Are you a citizen of the United States?

YES 

NO 

If no, are you authorized to work in the U.S.?

YES 

NO 

Do you hold a current first aid card?

YES  

NO  

 

 

Have you ever been convicted of a felony or misdemeanor within the last five (5) years?

YES  

NO  

If yes, explain

 

If you have any prior educational experience, please list on a separate sheet of paper.

Education

High School

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

College

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

Other

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

 

Military Service

Branch

 

From

 

To

 

Rank at Discharge

 

Type of Discharge

 

If other than honorable, explain

 

 

References

Please list three personal references.

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Previous Employment

Company

 

Phone

(           )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Is there any reason we cannot contact the above employers?

YES 

NO 

If Yes, please explain:

information release

 

I authorize my listed references, current and past employers and educational institutions, and anyone else who has information about my work history, education qualification, or fitness to provide such information to the school district for which I have completed an employment application. I release the school district and all persons providing this information to the school district, from any liability whatsoever for obtaining and providing that information, regardless of the results. Please indicate you have read and agree to these terms by placing both your INITIALS and DATE in the text box below.

Date/Initials  _______________________________________

Have you EVER been the subject of a substantiated report of child abuse or sexual misconduct (involving a K‐12 student or minor child)? If yes please explain.

YES__________ NO __________   If Yes, please explain:            

Are you currently the subject of an ongoing investigation related to a report of suspected child abuse or sexual misconduct (involving a K‐12 student or minor child)? If yes please explain.

YES__________ NO __________   If Yes, please explain: 

 

 

 

Application Process

Candidates may be invited for a personal interview. The administration reserves the right to decide who will be interviewed for any vacancies.

 

Information Release

I authorize Grant ESD to conduct background inquiry as to 1) Criminal History, 2) Financial History, and 3) Moral Turpitude, and I acknowledge that inquiries may be made to obtain job-related information from my previous employers, whether or not they are listed on the attached application and that similar inquiries may be directed to the persons listed as personal references as well as to any other individual who knows me.

 

I affirm that all information provided by me on this application is true and complete. I understand that if any part of the information is false or misrepresented (including omission of information called for), my application will not be considered, or if I am hired by Grant County ESD, this will be sufficient grounds for immediate dismissal.

 

A photocopy of this release shall be as effective as the original.

 

Signature

 

Date

 


 

EQUAL OPPORTUNITY

DRUG-FREE WORKPLACE

AMERICANS WITH DISABILITIES ACT

 

Grant County Education Service District, an equal opportunity employer, complies with provisions of the various civil rights laws, such as the Fair Employment Practice Act, Title IX Regulations and Section 504 of PL 93.112 in employment and educational programs and activities.

 

Grant Education Service District is committed to maintaining a drug-free workplace and strictly complies with the Drug-Free Workplace Act of 1988 and the Drug-Free Schools and Communities Act amendments of 1989.

 

Reasonable accommodations for the application and interview process will be provided upon request and as required in accordance with the Americans with disabilities Act of 1990. Disabled persons may contact Grant ESD Administrative Office, at 541-575-1349 for additional information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO NOT WRITE IN THIS SPACE—FOR OFFICE USE ONLY

Date Application Received:

Position Recommended For:

Years Experience Allowed:

Salary Step___________                              Starting Salary____________

Signature of Administrator: