Social Security Number
(Completion of social security is optional. Failure to submit social security number will not prohibit employment consideration. Your social security number will be required on various other employment documents.)
CURRENT EMPLOYMENT INFORMATION
(Undergraduate or Graduate)
For each employer, list the name, dates employed, job description, reason for leaving and supervisor's contact information.
(List three persons who know your professional background and qualifications. Do not list relatives.)
List their name, address and phone number.
ADDITIONAL BACKGROUND INFORMATION
PUBLIC LAW 93-389 "Family Educational Rights and Privacy Act of 1974"
I hereby certify that the information found within this application has been provided voluntarily and I waive any right to assert discrimination on the basis of that which has been divulged.
I hereby authorize all persons, firms, corporations, educational institutions, and organizations of any kind to release to the M.S.D. of Warren County any and all information, files, or records pertaining to this application, and to permit inspection, and to furnish copies of any documents pertinent to this application. I further authorize any and all persons in any capacity to answer any and all questions in any form that may be submitted to them concerning this application.
In the event of employment, I understand that false, misleading or omission of information given in my application or interview(s) may result in discharge.
I expressly waive in connection with any request for, or provision of such information any claims or accuses of action including, without limitation, defamation, infliction or emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the school district, its officials, employees, trustees or agents, or against any provider of any information.
I have read this authorization an release of all claims, and I expressly agree to the terms set out herein.
The information submitted on this application is accurate to the best of my knowledge. I understand that my application will be retained in current files for a period of one year.