Catoosa Public Schools

Please Fill Out The Support Staff Application Below

Date

Name

Address

City

State

Zip

Home Phone Number

Work Phone Number

Email Address

In case of emergency, please notify:

Are you 18 years of age or older

Yes

Are you legally eligible for employment in the United States? (Proof of eligibility will be required prior to employment.)

Yes

Name and relation of all relatives who work for Catoosa Public Schools, if any.

Position Applied For

Cafeteria

Custodial

Clerical

Bus Driver

Teachers Aide

Specific position applied for

Briefly state reason for interest in employment with Catoosa Public Schools

Have you previously applied for employment for Catoosa Public Schools? (If yes, please list the month and year applied)

Date available for work

Name of Present Employer or Most Recent

Address: City, State, Zip

Employer's Phone

May communicate with present employer?

Reaquired field: Yes

Reaquired field: No

Name and Title of Supervisor

Your Current Title

Employed From-To Dates

Describe Your Duties

Reason for Leaving

Name of Last Employer

Address: City, State, Zip *

Employers Phone

Name and Title of Supervisor

Employed From-To Dates

Describe your Duties

Reason for Leaving

Name of Last Employer

Address: City, State, Zip

Employer's Phone

Name and Title of Supervisor

Employed From-To Dates

Describe your Duties

Reason for Leaving

Name of Last Employer

Address: City, State, Zip

Employer's Phone

Name and Title of Supervisor

Employed From-To Dates

Describe your Duties

Reason for Leaving

High School Attended

Year Graduated

College or University Attended

Dates of Attendance

Major Field of Study

Minor Field of Study

Type of Degree

Year Earned

Have you ever failed to be reemployed?

Where?

If yes, please explain

Why do you wish to leave your present position?

On what date will you be available if offered employment at Catoosa Public Schools?

Have you ever entered a plea of guilty or nolo contendre to a state (any state) or federal charge? (This question includes criminal cases involving a "deferred sentence." "deferred judgement" and any "expunge of the records.")

Reaquired field: Yes

Reaquired field: No

Have you ever been convicted of a state (any state) or federal felony offense?

Reaquired field: Yes

Reaquired field: No

Have you ever been charged with a state (any state) or federal felony offense, which was reduced to a misdemeanor offense to which you entered a plea of guilty or nolo contendere? (This question includes criminal cases involving a "deferred sentence," "deferred judgement" and any "expunge of the records.")

Reaquired field: Yes

Reaquired field: No

Have you ever entered a plea of guilty or nolo contendere to, or been convicted of a state (any state) or federal misdemeanor charge involving illegal chemical substance or illegal sexual activity? (This question includes criminal cases involving a "deferred sentence," "deferred judgement" and any "expunge of the records.")

Reaquired field: Yes

Reaquired field: No

Have you ever entered into a deferred prosecution agreement with a state (any state) or federal prosecutor?

Reaquired field: Yes

Reaquired field: No

Have you ever been required to register as a sex offender under the Oklahoma Sex Offender Registration Act or under similar laws in another state?

Reaquired field: Yes

Reaquired field: No

Did you serve in the military

Yes

If yes, what branch of service?

Date Entered

Rank at Discharge

Type of discharge or separation

Date

Major Duties

Service Schools Attended

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Agreement (Please Read Carefully)

I hereby affirm that all statements made herein are true and correct. I authorize Catoosa Public Schools, District No. 2, Rogers County, to conduct whatever investigation it deems necessary to confirm information given on this application and in any interview. I understand and agree that any false or misleading information given or omission of a fact shall be sufficient grounds for summary dismissal. I authorize and request each former employer and person, school, firm or organization given as references, to answer any and all questions that may be asked, and to give any and all information that may be sought in connection with this application. I also certify that any person, agent, school, firm or organization who may furnish such information shall not be held accountable for giving this information; and I do hereby release said person, agent, school, firm or organization from any and all liability as a result of furnishing such information.

Signature (By typing your name, you agree that this is valid as your signature.)

Date

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