FAIRFIELD BOARD OF EDUCATION
6405 AVENUE D
FAIRFIELD, ALABAMA 35064
APPLICATION FOR NON-CERTIFIED POSITION
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| DATE:
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TYPE OF POSITION FOR WHICH APPLYING:
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If Services is selected, please specify skill area
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GENERAL INFORMATION |
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| SOCIAL SECURITY NUMBER:
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| LAST NAME:
FIRST NAME:
MIDDLE:
MAIDEN:
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| STREET:
CITY:
STATE:
ZIP:
TELEPHONE (ex: 205-555-5555):
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| SPOUSE (For identification and Retirement purposes only) |
LAST NAME:
FIRST NAME:
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| Have you ever been arrested or convicted?
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EDUCATIONAL DATA |
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HIGH
SCHOOL:
CITY:
STATE:
LAST YEAR ATTENDED :
GRADUATE:
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COLLEGE:
CITY:
STATE:
LAST YEAR ATTENDED :
DEGREE:
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OTHER FORMAL TRAINING :
CITY:
STATE:
LAST YEAR ATTENDED :
GRADUATE:
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EMPLOYMENT DATA
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LIST LAST THREE EMPLOYERS IN REVERSE CHRONOLOGICAL ORDER. |
- MOST RECENT EMPLOYER:
CITY:
STATE:
NUMBER OF YEARS:
FROM(ex: mmddyy):
TO(ex: mmddyy):
JOB TITLE:
- MOST RECENT EMPLOYER:
CITY:
STATE:
NUMBER OF YEARS:
FROM(ex: mmddyy):
TO(ex: mmddyy):
JOB TITLE:
- MOST RECENT EMPLOYER:
CITY:
STATE:
NUMBER OF YEARS:
FROM(ex: mmddyy):
TO(ex: mmddyy):
JOB TITLE:
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| OTHER SKILLS OR APTITUDES
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| HAVE YOU EVER BEEN AN EMPLOYEE OF THE FAIRFIELD BOARD OF EDUCATION?
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| IF YES, WHAT WAS YOUR NAME AT THE TIME OF EMPLOYMENT? (ex: last, name)
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| DO YOU HAVE ANY RELATIVES EMPLOYED WITH THE FAIRFIELD BOARD OF EDUCATION?
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| IF YES, PLEASE LIST : |
| NAME (ex: last, first) :
POSITION:
WHERE EMPLOYED:
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| NAME (ex: last, first) :
POSITION:
WHERE EMPLOYED:
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| NAME (ex: last, first) :
POSITION:
WHERE EMPLOYED:
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REFERENCES |
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| PLEASE LIST THREE PROFESSIONAL REFERENCES WHO ARE FAMILIAR WITH YOUR WORK, ONE MUST BE LAST OR CURRENT SUPERVISOR. |
- NAME (ex: last, first) :
STREET:
CITY:
STATE:
TELEPHONE (ex: 205-555-5555):
- NAME (ex: last, first) :
STREET:
CITY:
STATE:
TELEPHONE (ex: 205-555-5555):
- NAME (ex: last, first) :
STREET:
CITY:
STATE:
TELEPHONE (ex: 205-555-5555):
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DRIVERS LICENSE |
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DO YOU HAVE A VALID DRIVER'S LICENSE?
IF YES, LICENSE NUMBER:
EXP DATE (mmddyy):
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| LIST ALL TRAFFIC VIOLATIONS WITHIN THE LAST FIVE YEARS |
| VIOLATION:
CITY:
STATE:
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| VIOLATION:
CITY:
STATE:
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| VIOLATION:
CITY:
STATE:
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| VIOLATION:
CITY:
STATE:
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| WOULD YOU BE WILLING TO SUBMIT A PHYSICAL EXAMINATION ?
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Resume:
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DIGITAL SIGNATURE |
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****I CERTIFY THAT THE INFORMATION I HAVE GIVEN ON THIS APPLICATION IS TRUE AND COMPLETE**** |
| APPLICANT SIGNATURE (ex: last, name)
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| ***NOTE: ALL EMPLOYEES ASSIGNED TO MAINTENANCE MUST HAVE A VALID ALABAMA DRIVER'S LICENSE AND MUST BE INSURABLE BY THE SCHOOL SYSTEM'S INSURANCE CARRIER. |
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| IT IS THE OFFICIAL POLICY OF THE FAIRFIELD BOARD OF EDUCATION THAT NO PERSON SHALL BE DISCRIMINATED AGAINST ON THE GROUNDS OF THEIR RACE, COLOR, HANDICAP, SEX, RELIGION, CREED, NATIONAL ORIGIN, OR AGE. |
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