CONCORDIA PARISH SCHOOL BOARD

Central Office

4358 Highway 84 West

P.O. Box 950

Vidalia, LA 71373

Phone: (318) 336-4226

EMPLOYMENT APPLICATION

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Date ______Social Security # ______

Name ______Telephone # ______

Present Address ______City ______State ______Zip ______

Position Desired (1) ______(2) ______(3) ______

Salary Desired ______Relatives in our employment ______

EDUCATIONAL PREPARATION

HIGH SCHOOL

Mo./Yr.
From /
To / / Name & Address of School / Field of Study / Graduated Year
Yes ____ No ______

COLLEGE

Mo./Yr.
From /
To / / Name & Address of School / Ungrad Major / Ungrad Minor / Graduate Major
Mo./Yr.
From /
To / / Name & Address of School

Degree(s) Earned ______What College______Year______

Special Courses/Training ______

______

Machines that you can operate ______

List Computer Skills ______

______

Do you have a driver’s license: ______Regular ______Commercial ______State ______

EMPLOYMENT HISTORY

List last employer first. Be complete and accurate.

Mo./Yr.
From /
To / / Name and Address of Employer / Po sition Held / Supervisor / Ending Salary
Mo./Yr.
From /
To /
Mo./Yr.
From /
To /

ACCOUNT FOR ANY TIME INTERVALS OF UNEMPLOYMENT OTHER THAN SCHOOL

Mo./Yr.
From /
To / / Explanation
Mo./Yr.
From /
To /

REFERENCES

Please name three (3) persons not relatives or former employers who have known you for five (5) years or more.

Name
1) / Address (complete) / Employment title / Phone
2)
3)

READ CAREFULLY

Background checks are done on all applicants/employees. Will any charges or violations of the law be reported on the Criminal History Report? ____ Yes ____ No

Have you ever been convicted of a felony offense involving moral turpitude (including, but not limited to, theft, rape, murder, swindling, or indecency with a minor)? _____ Yes _____ No

VALIDITY OF THIS APPLICATION IS BASED UPON THE FOLLOWING POINTS.

·  Accuracy of all pre-employment information furnished.

·  Satisfactory reference reports.

·  Bona Fide job qualifications.

*Incorrect information will void this application.

I HEREBY AGREE FOR THIS EMPLOYING AGENCY TO VERIFY ANY OR ALL INFORMATION PLACED ON THIS APPLICATION.

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Signature of Applicant Date

DO NOT WRITE BELOW THIS LINE

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