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Carterville CUSD #5
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Support Staff Application
24 Questions
1) Full Name:
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2) Address:
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3) Phone Number:
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4) Social Security Number:
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5) Email:
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6) What position(s) are you applying for?
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7) Please select the date that you are available to start?
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8) What hours are you available to work?
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9) Are you currently employed?
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No
Yes, and feel free to contact my current employer.
Yes, but DO NOT contact my current employer at this time.
10) Do you have any relatives that currently work in the district? If yes, please share the name of the employee and your relationship.
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11) Bus driver applicants: Did an employee of Carterville CUSD #5 refer you for this position? If yes, please list the name of the employee who referred you. (Answer N/A if this question does not apply)
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12) Please list your high school and graduation date.
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13) Please list all other educational experience. (Ex. College/Degree, Trade School/Degree)
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14) Describe any job-related training received in the US Military:
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15) Starting with your most recent job, list your employment history including: Name of employer, start/end date, position held, and reason for leaving.
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16) List the names of three references (not related to you), whom you have known for at least one year. (Name, address, and phone number)
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17) Summarize special job-related skills and qualifications acquired from employment or other experience that will help you succeed in the position of interest?
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18) State any additional information that you would like the district to consider when reviewing your application.
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19) Do you have any physical limitations that will preclude you from performing any work for which you are applying? If yes, what can be done to accommodate your limitations?
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20) Please list emergency contacts. (Name, Phone Number(s))
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21) I certify that the facts shared in this application are true and complete to the best of my knowledge and, if employed, falsified statements on this application are grounds for dismissal.
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Yes, I certify the accuracy of this application.
No, I will not certify the accuracy of this application.
22) I authorize the investigation of all statements contained herein, worker compensation claims, and references listed to give you any information regarding previous employment.
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Yes, I authorize.
No, I do not authorize.
23) I authorize an investigation to determine if I have been convicted of any of the specified criminal or drug offenses and agree that a conviction record shall terminate my employment.
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I authorize the background investigation.
I DO NOT authorize the background investigation.
24) I understand and agree that, if hired, I am required to abide by all rules and regulations of the employer.
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I agree.
I DO NOT agree.
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