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NORTHERN YORK COUNTY SCHOOL DISTRICT149 S. BALTIMORE STREETDILLSBURG, PA 17019717-432-8691 Ext.1104SUPPORT STAFF APPLICATION(Please Print)Date:____________Email Address:____________________What Position are you applying for? __________________________________________Name_______________________________________________________________________(last)(first)(middle initial)Address:_____________________________________________________________________(street)(city)(state)(zip)Telephone: ___________________________Social Security:_____________________Do you have the legal right to live and work in the United States? Yes____ No____Have you ever been convicted of a misdemeanor and/or a Felony? Yes ____ No____If Yes, What and Explain___________________________________________________________________________________________________________________________________Do you have a valid Pennsylvania Driver’s License? Yes _____ No_____Date available for Position? ____________________Are you currently employed? ____________________If so, where? ____________________________________________________________Why are you applying for a position with the school district? __________________________________________________________________________________________________EDUCATIONSCHOOLCITYDATES ATTENDEDElementary__________________________________________________________________High School _________________________________________________________________Education after School _______________________________________________________Number of years completed ___________________________________Degree Received ______________________________WORK EXPERIENCECOMPANYPOSITIONSUPERVISORYEARS WORKED1.____________________________________________________________________________2.____________________________________________________________________________3. ___________________________________________________________________________REFERENCES (Do not use relatives)NAMEADDRESSPHONE1._________________________________________________________________________2. _________________________________________________________________________3. __________________________________________________________________________Please list any other information that in your opinion would be helpful in considering your application______________________________________________________________________________________________________________________________________________Applicant’s Signature __________________________________The Northern York County School District is an equal opportunity educational institution and will not discriminate on the basis of race, color, religion, national origin, sex, or handicap in its activities, programs, or employment practices as required by Title VI, Title IX and Section 504 and the Americans with Disabilities Act. ................
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