LOWER MORELAND SCHOOL DISTRICT APPLICATION FOR …



LOWER MORELAND SCHOOL DISTRICT APPLICATION FOR EMPLOYMENT

2551 MURRAY AVENUE

HUNTINGDON VALLEY, PA 19006 DATE:_____________________________________

NAME:_______________________________________ S.S.#:_________________________________

ADDRESS/ZIP CODE:___________________________________________________________________

PHONE NUMBER:____________________ POSITION APPLIED FOR:_____________________________

RATE OF PAY EXPECTED:__________________ DATE AVAILABLE:_____________________________

CLERICAL APPLICANTS: COMPUTER SKILLS:________________________________________

CHECK ALL THAT APPLY: MICROSOFT OFFICE ________

OTHER ________

BUSINESS MACHINES YOU CAN OPERATE:__________________________________________________

EDUCATION:

| | | | |

|SCHOOL |LOCATION |DATES ATTENDED |GRADUATED |

| | | | |

| | | | |

| | | | |

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MILITARY SERVICE:

WERE YOU IN U.S. ARMED FORCES?___________ IF YES, WHAT BRANCH?_____________________

RANK:_______________________ TYPE AND DATE OF DISCHARGE:____________________________

AREAS OF SPECIAL TRAINING:__________________________________________________________

REFERENCES:

| | | |

|NAME |ADDRESS |PHONE NUMBER |

| | | |

| | | |

| | | |

WERE YOU EMPLOYED WITHIN THE PENNSYLVANIA PUBLIC SCHOOL SYSTEM PRIOR TO JULY 1, 1994?

( Yes ( No

(OVER)

EMPLOYMENT HISTORY:

LIST BELOW PRESENT AND PAST EMPLOYMENT, BEGINNING WITH MOST RECENT:

| | | | | | |

|NAME & LOCATION OF EMPLOYER |FROM |TO |DUTIES |SALARY |REASON |

|& SUPERVISOR(S NAME |MO/YR |MO/YR | | |FOR LEAVING |

| | | | | | |

|1. | | | | | |

| | | | | | |

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| | | | | | |

|2. | | | | | |

| | | | | | |

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| | | | | | |

|3. | | | | | |

| | | | | | |

| | | | | | |

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|4. | | | | | |

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Please indicate by number the employers you do not wish us to contact:______________

Dear Applicant:

The Lower Moreland School District is an Equal Opportunity Employer. Persons will be employed regardless of race, creed, religion, color, sex, national origin, age, or handicap (not job related).

NOTE: The Pennsylvania Board of Health requires a tuberculosis tine test or chest X-Ray for all school employees. Before beginning work for the district, you must submit proof of a recent tine test or results of an X-Ray less than two years old.

NOTE: Act 34 of 1985, Section III of the Public School Code specifies that employees of public and private schools hired as of January 1, 1986, must undergo background checks. If you are a resident of Pennsylvania you must secure form SP4-164 from either the Pa. State Police or the School District and submit it to the Commonwealth in Harrisburg. If you are a non-resident of Pennsylvania, in addition to the background check you will also need an FBI fingerprint card from the Pennsylvania Department of Education. As of July 1, 1996, the Act 151 Clearance Form must also be obtained.

_______________________________________________ ______________________________

Applicant Signature Date

FORMS-APPLICATION

09/30/09

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