FORT TOWSON PUBLIC SCHOOLS Post Office Box 39 Fort Towson, Oklahoma 74735

FORT TOWSON PUBLIC SCHOOLSPost Office Box 39  Fort Towson, Oklahoma 74735

NEW EMPLOYEE PACKET

Full Legal Name:

Address:

SS#:DOB:Race:

Phone number: Cell:Home:

Ok Teacher Number:

Years of Experience in Oklahoma:Out of state:

Previous School District Name:

Phone Number for Previous School District:

Are you taking the school Health Insurance? Y/N

If no, Why?

Do you want to enroll in Teacher Retirement? Y / N

Are you CDL certified? Y/NWith bus? Y/N

New employees must provide a current background check, attach a copy of a valid Drivers License and Social Security Card. If certified to teach in Oklahoma, attach a valid teaching certificate and a college transcript.

I hereby authorize Fort Towson Public School, hereinafter called, Company, to initiate credit entries and to initiate, if necessary debit entries and adjustments for any credit entry in error to my account indicated below and the financial institution named below, hereinafter called Depository, to credit and/or debit the same such account. This authority is to remain in full force and effect until Company has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it.

______

Employee Signature

DATE NAME AS LISTED ON ACCOUNT (PRINT) FINANCIAL INSTITUTION NAME

CHECK ONE:

I am not currently participating in the Direct Deposit Program

( ) ADD – Deposit my pay to the account shown*

I am currently participating in the Direct Deposit Program

( ) CHANGE – Change financial institutions and/or account number.*

*Due to the time required for Company and bank processing, allow one or two pay periods for processing. You will be receiving a regular paycheck until the change can be processed.

IMPORTANT! CHECK TYPE OF ACCOUNT: ( ) CHECKING( ) SAVINGS

TAPE YOUR VOIDED CHECK HERE

FLOWER FUND PAYROLL DEDUCTION FORM

DATE______

I______, will pay $20.00 by personal check or cash to donate to the Flower Fund.

I______, request and give permission to have $20.00 payroll deducted for the Flower Fund donation.

I______, request to be exempt from the Flower Fund. I understand that by not donating to the Flower Fund I will not receive a gift from the Flower Fund in the event of hospitalization, birth, death, marriage or retirement.

______

Employee NameEmployee Signature

Fort Towson Public School ISD #I002

Agency, Authority, Commission, Department or InstitutionAgency No.

Post Office Box 39 Fort Towson, OK 74735

Address City State Zip

______

Name of Employee

LOYALTY OATH

(51 O.S. ξ36.2A)

I do solemnly swear (or affirm) that I will support the Constitution and the laws of the United States of America and the Constitution and the laws of the State of Oklahoma and that I will faithfully discharge according to the best of my ability, the duties of my office or employment during such time as I am an employee of The Fort Towson Public School System .

______

Affiant (Signature)

Subscribed and sworn to before me this ______day of ______, 20___

(Seal)______

Notary Public

My Commission # Expires ______

Dear Applicant,

Thank you for your interest in a career at Fort Towson Public School.

Please complete the attached application for employment, W-4 form and Part 1 on the application for a National Criminal History Record Check.

DO NOT FILL OUT ANYTHING ON THE FINGERPRINT CARDS. Take the two fingerprint cards to the Choctaw County Jailat305 E Jefferson St, Hugo, OK 74743 ((580) 326-2130) on Monday, Tuesday, Thursday or Friday from 9:00-11:30 or 1:00-5:00. You will need to have $15 cash (in exact change) and a picture ID.

Bring the attached application for a National Criminal History Record Check, your fingerprint cards, a $45 money order (not cash or check) payable to OSBI, teaching certificate (if applicable), CDL (if applicable) and two forms of identification with your completed application back to Fort Towson Public School Superintendents Office for processing.

Applicant Information PLEASE PROVIDE 2 FORMS OF I.D. Date:

Last Name / First / M.I. / DOB
Street Address / Apartment/Unit #
City / State / ZIP
Phone / E-mail Address
Date Available / Social Security No. / Race:
Position Applied for
Are you a citizen of the United States? / YES / NO / If no, are you authorized to work in the U.S.? / YES / NO
Have you ever worked for this company? / YES / NO / If so, when?
Have you ever been convicted of a felony? / YES / NO / If yes, explain

Education

High School / Address
From / To / Did you graduate? / YES / NO / Degree
College / Address
From / To / Did you graduate? / YES / NO / Degree
Other / Address
From / To / Did you graduate? / YES / NO / Degree

References

Please list three professional references.
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address

Previous Employment

Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO

Military Service

Branch / From / To
Rank at Discharge / Type of Discharge
If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature / Date

This page to be completed by Teacher, Administrative or Bus Driver applicants only