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Non-Instructional Employment Application

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Sullivan West Central School District

33 Schoolhouse Road, Jeffersonville, NY 12748

Non-Instructional Employment Application

Personal Information

How did you hear about this position?*
Answer required for "How did you hear about this position?"

Placement Information

Type of Employment: (check all that apply)*
Answer required for "Type of Employment: (check all that apply)"

Education & Skills

Did you Graduate?
Answer required for "Did you Graduate?"

Sullivan West Central School District is an equal opportunity employer.
Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity, marital status, veteran status, disability, or any other protected category under state and federal law.
The District is interested in diversifying staff to represent/reflect the cultural diversity of the community. Persons of color are encouraged to apply.

Please return your application to:
Daniel Parisi, Assistant Superintendent
Sullivan West Central School District
33 Schoolhouse Road, Jeffersonville, NY 12748
Email: [email protected]

Employment History

Employer One

Contact Information
Address
State
Answer required for "State"
Is this your current employer?
Answer required for "Is this your current employer?"
May we contact this employer?
Answer required for "May we contact this employer?"

Employer Two

Address
State
Answer required for "State"

Employer Three

Address
State
Answer required for "State"

Please answer ALL OF the following questions.

Have you ever been convicted of a felony?*
Answer required for "Have you ever been convicted of a felony?"
Are there any arrests currently pending against you?*
Answer required for "Are there any arrests currently pending against you?"
Have you ever been fingerprinted for the purpose of employment?*
Answer required for "Have you ever been fingerprinted for the purpose of employment?"
Have you ever been terminated from employment?*
Answer required for "Have you ever been terminated from employment?"
Have you ever been discharged or required to resign from any position (other than staff reduction layoffs)?*
Answer required for "Have you ever been discharged or required to resign from any position (other than staff reduction layoffs)?"
Have you every resigned as an alternative to facing charges or dismissal?*
Answer required for "Have you every resigned as an alternative to facing charges or dismissal?"
Have you ever been disqualified for employment for any civil service position?*
Answer required for "Have you ever been disqualified for employment for any civil service position?"
Have you ever been found guilty and/or pleaded guilty to disciplinary charges brought against you?*
Answer required for "Have you ever been found guilty and/or pleaded guilty to disciplinary charges brought against you?"
Have you ever had any professional certificate or license denied, revoked or suspended by any government agency?*
Answer required for "Have you ever had any professional certificate or license denied, revoked or suspended by any government agency?"
Has Family Court, or any other court, ever rendered a finding indicating that you have abused or neglected a child?*
Answer required for "Has Family Court, or any other court, ever rendered a finding indicating that you have abused or neglected a child?"
Are you a citizen of the United States?*
Answer required for "Are you a citizen of the United States?"
Have you ever served in the Armed Forces?*
Answer required for "Have you ever served in the Armed Forces?"
Have you ever worked at Sullivan West Central School District?*
Answer required for "Have you ever worked at Sullivan West Central School District?"
Are there any reasons why you would not be able to perform any of the activities of the position for which you have applied?*
Answer required for "Are there any reasons why you would not be able to perform any of the activities of the position for which you have applied?"
Are you receiving benefits from a governmental retirement plan in New York State?*
Answer required for "Are you receiving benefits from a governmental retirement plan in New York State?"

References (list references who are knowledgeable as to your professional experiences and work habits, include direct supervisors)

Reference One

Reference Two

Reference Three

Applicant's Statement

I certify that the facts and responses provided herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information in my application or interview(s) may result in disqualification of this application or termination of employment. I acknowledge employment is subject to a fingerprint and criminal check. I understand that I am required to abide by all rules and regulations of Sullivan West Central School District.

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