certificated application
GARDEN VALLEY SCHOOL DISTRICT #71 P.O. Box 710, Garden Valley, Idaho 83622 Phone (208) 462-3756 / Fax (208) 462-3570 / www.gvsd.net
CERTIFICATED APPLICATION
Date: __________________________ Position applied for: ________________________________________________________________________ Name: ____________________________________________________________________________________ First
Middle
Last
Present Address: ____________________________________________ Tel: (
) _____-_______________
City, State, Zip _______________________________________Alternate Tel/Cell: (
) _____-__________
E-mail address: _______________________________________ The following information is requested in order to monitor our Affirmative Action Program and to insure equal employment opportunity. While you are not required to complete this section, your cooperation on providing the data is appreciated.
Gender:
Male: ____ Female: ____
Ethnicity: White: ____ Hispanic: ____ Asian: ____ Black: ____ American Indian or Alaska Native: ____ Native Hawaiian or Pacific Islander: ____ Other: ____ My reasons for applying for a position with the Garden Valley School District are:
1. Have you worked for Garden Valley School District in the past? Yes If so, when? ______________________
No
2. REFERENCES – Please include three current letters of recommendation along with three references that we may contact on your behalf. Please be sure that letters of recommendation and references are within the last three years. 3. Your complete application must include: •
On separate pages, please identify three important contemporary professional issues, trends, problems, etc., which are of personal concern to you, and discuss one of them in terms of its significance or implications for public education. Please limit your narrative to not less than 300 words nor more than 1,000 words.
•
Please attach a resume to this application
GARDEN VALLEY SCHOOL DISTRICT #71 P.O. Box 710, Garden Valley, Idaho 83622 Phone (208) 462-3756 Fax (208) 462-3570 www.gvsd.net *** CONSENT/RELEASE STATEMENT ***
I ______________________________________________________________________ First
Middle
Last
Also known as: _______________________________________________________________________ (Include maiden and/or prior married names, etc.)
Social Security Number: _________-________-__________ Hereby authorize Garden Valley School District #71 to receive any and all information concerning myself contained within the files of the Bureau of Criminal Investigations. ___________________________________ Signature
________________________ Date
Have you ever been convicted of a misdemeanor other than a traffic violation? ___________ If so, please explain on a separate sheet of paper or on the back. Have you ever been convicted of a felony? ___________ If so, please explain on a separate sheet of paper or on the back. I certify that all claims and statements made by me in connection with this application and resume are substantially true and correct to the best of my knowledge, and that all supporting statements and documents are what they are represented as being. I understand that it is the policy of the Garden Valley School District: To respect the privacy rights of job applicants to the extent that information about the private lives and personal affairs of identifiable persons is not treated as public information; Neither to solicit nor to accept for use in its personnel selection procedures any secret or confidential evaluations of or information about job applicants; To withhold from its employees and applicants for employment only that information which the employee or applicant has, by prior written agreement with his or her placement service, waived access to. ___________________________________ Signature
________________________ Date
Idaho Code 33-130 requires that all employees be fingerprinted and undergo an F.B.I. background check. The cost of the background check is $40.00 and will be paid by the district. The cost of the completion of the fingerprint card, if applicable, will be paid by the applicant.
Garden Valley School District does not discriminate on the basis of race, color, creed, national origin, religion, age, disability or sex in educational programs, activities or employment practice. - District Policy 281 & 284 Civil Rights and Title IX Coordinator / Superintendent, Box 710, Garden Valley, ID 83622 (208) 462-3756
CERTIFICATED APPLICATION
Date: __________________________ Position applied for: ________________________________________________________________________ Name: ____________________________________________________________________________________ First
Middle
Last
Present Address: ____________________________________________ Tel: (
) _____-_______________
City, State, Zip _______________________________________Alternate Tel/Cell: (
) _____-__________
E-mail address: _______________________________________ The following information is requested in order to monitor our Affirmative Action Program and to insure equal employment opportunity. While you are not required to complete this section, your cooperation on providing the data is appreciated.
Gender:
Male: ____ Female: ____
Ethnicity: White: ____ Hispanic: ____ Asian: ____ Black: ____ American Indian or Alaska Native: ____ Native Hawaiian or Pacific Islander: ____ Other: ____ My reasons for applying for a position with the Garden Valley School District are:
1. Have you worked for Garden Valley School District in the past? Yes If so, when? ______________________
No
2. REFERENCES – Please include three current letters of recommendation along with three references that we may contact on your behalf. Please be sure that letters of recommendation and references are within the last three years. 3. Your complete application must include: •
On separate pages, please identify three important contemporary professional issues, trends, problems, etc., which are of personal concern to you, and discuss one of them in terms of its significance or implications for public education. Please limit your narrative to not less than 300 words nor more than 1,000 words.
•
Please attach a resume to this application
GARDEN VALLEY SCHOOL DISTRICT #71 P.O. Box 710, Garden Valley, Idaho 83622 Phone (208) 462-3756 Fax (208) 462-3570 www.gvsd.net *** CONSENT/RELEASE STATEMENT ***
I ______________________________________________________________________ First
Middle
Last
Also known as: _______________________________________________________________________ (Include maiden and/or prior married names, etc.)
Social Security Number: _________-________-__________ Hereby authorize Garden Valley School District #71 to receive any and all information concerning myself contained within the files of the Bureau of Criminal Investigations. ___________________________________ Signature
________________________ Date
Have you ever been convicted of a misdemeanor other than a traffic violation? ___________ If so, please explain on a separate sheet of paper or on the back. Have you ever been convicted of a felony? ___________ If so, please explain on a separate sheet of paper or on the back. I certify that all claims and statements made by me in connection with this application and resume are substantially true and correct to the best of my knowledge, and that all supporting statements and documents are what they are represented as being. I understand that it is the policy of the Garden Valley School District: To respect the privacy rights of job applicants to the extent that information about the private lives and personal affairs of identifiable persons is not treated as public information; Neither to solicit nor to accept for use in its personnel selection procedures any secret or confidential evaluations of or information about job applicants; To withhold from its employees and applicants for employment only that information which the employee or applicant has, by prior written agreement with his or her placement service, waived access to. ___________________________________ Signature
________________________ Date
Idaho Code 33-130 requires that all employees be fingerprinted and undergo an F.B.I. background check. The cost of the background check is $40.00 and will be paid by the district. The cost of the completion of the fingerprint card, if applicable, will be paid by the applicant.
Garden Valley School District does not discriminate on the basis of race, color, creed, national origin, religion, age, disability or sex in educational programs, activities or employment practice. - District Policy 281 & 284 Civil Rights and Title IX Coordinator / Superintendent, Box 710, Garden Valley, ID 83622 (208) 462-3756
