Application for Employment in a Coaching Position

La Cañada Unified School District

4490 Cornishon Ave, LaCañada, California91011

(818) 952-8385

FAX (818) 952-8309

APPLICATION FOR EMPLOYMENT IN A COACHING POSITION

Coaching Position (Sport) Desired: / Date:
Name: / --
LastFirstMiddle / Social Security Number
Address:
StreetCityStateZip Code
-- / --ext. / --
Home Phone / Work Phone / Fax / E-Mail
Coaching Experience:
Have you ever been employed by LCUSD in a coaching position? Yes No If yes, please provide dates of service:
Date of Last Mantoux (TB test): / Date of Fingerprints:
First Aid Course Expiration Date:
CPR Course Expiration Date:
Are you legally eligible for work in the United States? Yes No
Have you ever been dismissed or asked to resign by an employer? Yes No If yes, please provide explanation.

Other than routine traffic violations, have you ever been convicted of a crime? Yes No (Check “Yes” even if no conviction resulted but the outcome is pending.) NOTE: DO NOT list convictions for marijuana possession or use occurring more than two years ago unless the possession or use was on the grounds of a school (California Labor Code Section 432.7). If you checked “Yes,” give details below.

It is the policy of the La Cañada Unified School District not to discriminate on the basis of race, religion, color, national origin, ancestry, disability, medical condition, marital status, sex, age, sexual orientation or any other unlawful basis in its educational programs, activities or employment policies as required by Title IX of the 1972 Educational Amendments, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act, the California Fair Employment and Housing Act, and other applicable laws and regulations.

Individuals with disabilities who require assistance or special arrangements to participate in a program or activity sponsored by the personnel office of La Cañada Unified School District, please contact Danielle Newcom at (818) 952-8385. We request that you provide 48-hour notice so that the proper arrangements can be made.

I HEREBY CERTIFY that all statements made hereon are true and correct to the best of my knowledge and authorize investigation of all statements herein recorded. I release from liability persons and organizations reporting information required by this application. Any misstatements or omissions of material fact in your application may be cause for dismissal.

Signature of Applicant: ______Date: ______

This copy was downloaded from the LCUSD Internet Site at: