Jansen Cable Construction, Inc



Bond County CUSD #2

|Name: (Last, First, M.I.) |

|Address: |

|City: |State: |Zip Code: |

|Email Address: |

|Home Phone ( ) Cell Phone ( ) |

|Work Phone ( ) |

|May we Contact you at work ( Yes ( No |

|Position Applying For: |

By signing below, I understand that misstatements or omissions of information in connection with my application for employment can lead to rejection of my application or dismissal from employment, when discovered. I also, authorize the school district to request references from my former employers, and I acknowledge that consideration for employment is contingent on the results of a reference and background check. Therefore, I hereby authorize the school district to analyze the truthfulness of all statements made on this application; and to discuss those results with other employees of the school district involved in the hiring process. In addition, I give my consent for all contacted persons including former employers to provide information concerning this application, and I release each such person from liability for providing information to the school district.

I understand that nothing contained in this application, or the granting of an interview is intended to create an employer/employee relationship between the school district and myself either for employment or for the providing of any benefits. No promises regarding employment have been made to me unless made in writing. I further understand and agree that if I am hired, my employment would be "at will," as defined by law where Bond County CUSD #2 operates, I would have the right to terminate my employment at any time for any reason and that the school district would retain a similar right

I understand that any offers of employment will be contingent upon my taking and successfully passing a drug and/or alcohol test in accordance with the school district’s policy. If I refuse to submit to testing, refuse to sign the school district consent form, or test positive, the school district will not employ me.

I hereby attest that all statements made by me above are true to the best of my knowledge, and I agree to the terms noted above.

Date: _________ Applicant's Signature: ________________________________________

Personal Data

|Name: | |Date: | |

| (Last Name) (First Name) (Middle) |

|Address: | | | | |

| (Number) (Street) (City) (State) (Zip |

|Code) |

|Social Security # | |Telephone # |( ) |

|Telephone # & Name to contact in case of Emergency | (Name) |

| |( ) |

|I am (Check a Box) & Will provide necessary documentation to validate that I am |

|( A citizen or national of the United States or |

|( Authorized by the Immigration and Naturalization Service to work in the United States |

|Have you ever been convicted of a crime (other than minor traffic violations)? |

|( Yes ( No |

| |

|If yes, when, where, and disposition of the conviction: __________________________________ |

|Note: An applicant for employment is not obligated to disclose sealed or expunged records of conviction or arrest. |

|What type of experience do you have which would be helpful for the job you are applying for? |

| |

|___________________________________________________________________________________ |

|Have you ever worked for this school district before? ( Yes ( No |

|If yes, when & where ____________________________________________________________________________ |

| |

|Date available |

|to Start: |

|Are you available to Work: ( Full-time ( Part-time ( Days ( Nights (Weekends |

|List any day or hours you are unable to work: ___________________________________ |

| | |

| | |

|List Any Friends or Relatives working | |

|here: | |

| | |

| | (Name) (Relationship) |

| | |

| | (Name) (Relationship) |

|Please Indicate your source of referral: |

|( Company Employee ( Newspaper ( Employment Agency ( Contacted On Own ( Other |

|Name: _____________ Name: _______________ _________ |

United States Military Service

| | |

|Do you have United States Military Experience? ( Yes ( No |Branch: _________________________ |

|Date Entered: | |Date Discharged: | |Rank at Time of Discharge: | |

|Special Skills or Training from | |Present Military Status: | |

|Service: | | | |

EDUCATION

| Name & Location of School |Please Circle Last Year Degree |Year |Course Work |

| |Completed |Graduated | |

|{High School} |1 2 3 4 | | |

| | | | |

| | | | |

|{College} |1 2 3 4 | | |

|{Other} |1 2 3 4| | |

| | | | |

| | | | |

WORK EXPERIENCE: List below your last four employers, starting with the most current one.

|Company Name: |Address: |

|Position: |Earnings – Beginning Ending |Dates - From To |

|Supervisor -Name and Title |Phone |

| |( ) |

|Reason for Leaving |

|Company Name: |Address: |

|Position: |Earnings - Beginning Ending |Dates - From To |

|Supervisor - Name and Title |Phone |

| |( ) |

|Reason for Leaving |

|Company Name: |Address: |

| | |

|Position: |Earnings - Beginning Ending |Dates - From To |

|Supervisor Name and Title |Phone |

| |( ) |

|Reason for Leaving |

|Company Name: |Address: |

| | |

|Position: |Earnings - Beginning Ending |Dates - From To |

|Supervisor Name and Title |Phone |

| |( ) |

|Reason for Leaving |

| |

| |

|Additional Experience |

|Please List Any additional experience |

|____________________________________________________________________________________ |

| |

Are there any other places you have worked in addition to those listed above? ( Yes ( No

Please complete the following section if applying for a

certified position

Major: _______________________________ No. of Hours: __________________________

Minors: ______________________________ No. of Hours: __________________________

Are you now under contract to teach? YES NO

If applying for an elementary position, can you teach music in a self-contained classroom?

YES NO

Art? YES NO

If applying for a high school or junior high position, what subjects are you certified to teach in Illinois? ____________________________________________________________________________________________________________________________________________________________________________

At what grade level did you student teach? ______________________ Where: ______________________

Which extra class activities (including intramurals and/or interscholastic athletics) will you be willing to direct? ________________________________________________________________________________

______________________________________________________________________________________

Do you hold a valid Illinois Certificate? YES NO

What type(s): __________________________________________________________________________

Certificate No.: _______________________________

Please complete the following section if applying for a

substitute teaching position

What is your preference for substituting?

_________ Elementary _____________ Jr. High _________ High School

Do you have a valid Illinois Certificate? YES NO What type?:________________

Number of Certificate _______________________________

You must be registered with _____(ROE)______________________________________

Please complete the following section if applying for a

bus driving position

|Are you 21 years of age or older? ( Yes ( No |

|State, number & expiration date of each unexpired motor vehicle operator’s license. |

|Types and extent of experience in the operation of motor vehicles. |

|(Ex. Buses, trucks, trailers) |

| |

| |

| |

|Has your driver’s license been revoked, suspended, canceled or disqualified in the past three years? ( Yes ( No |

|List all motor vehicle accidents in the last three years specifying date, nature of the accident(s) and any fatalities or injuries |

|involved. |

|List all violations of motor vehicle laws or ordinances of which you were convicted, or forfeited bond in the past three years. |

|If you were an operator of a commercial vehicle in the past 10 years, please list all employers, dates of employment, and reason for |

|leaving. |

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Employment Application

(An Equal Opportunity Employer)

This Application will be maintained for 6 months only

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