Certified Staff Application | Ramsay School District #3

First Name *

Last Name *

Position Applied For *

Street Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country

Previous Name(s)

Home Phone *

Cell Phone *

Email Address *

Date Available For Work *

What class license and endorsement(s) do you hold?

Montana

Endorsement(s)

Expiration Date

Other State

Endorsement(s)

Expiration Date

Montana Folio Number

Do you have the legal right to work in the United States? *YesNo

Are you able, with or without reasonable accommodation, to perform the functions of the job for which you are applying? *YesNo

Have you ever been released or discharged from employment or resigned to avoid such release or discharge? *YesNo

Please explain. Include date of discharge or resignation and reason for discharge or resignation.

I hereby certify that (check the applicable box and provide the information requested): *Please note that answers to this question may not necessarily disqualify an application from consideration for employmentI have not pleaded guilty to, nor have I been convicted of, any violation of criminal law (minor traffic offenses excepted).I have pleaded guilty to, or I have been convicted of, at least one violation of criminal law, including criminal convictions resulting from a deferred sentence or plea of nolo contendere/no contest (minor traffic offenses excepted).

Please describe the circumstances surrounding all convictions.

Employment Record

List your employment, with your most recent employment first. Describe your employment history, accounting for the last 5 positions held. You may include volunteer and paid experience. DO NOT substitute a resume. You may attach additional information.

Recent Employment

Past Employer

Position

Years in position

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Contact Person

Title

Telephone

Years Employed

To

Highest Salary

Reason(s) For Leaving

Please list current information for three references.

Name

Title

Email Address

Home & Work Phone

Name

Title

Email Address

Home & Work Phone

Name

Title

Email Address

Home & Work Phone

Education History

Highest Degree Earned

List from most recent to least recent attendance

Education

Institution

Location

Degree

Year

Upload any additional information or documentation that you would like us to review concerning your application.

Upload additional information

Equal Opportunity Employer

Each participating school district prohibits discrimination against or harassment of any person employed by or seeking employment with the school district because of race, religion, color, sex, national origin or because of age, physical or mental disability, or genetic information, when the reasonable demands of the position do not require an age, physical or mental disability, marital status, or gender distinction. People of disability may request reasonable accommodation in the hiring process by contacting the school district personnel office.

Proof of Employability

Any applicant chosen for employment must be able to produce a social security card, driver's license, or some other acceptable form of verification of employment eligibility in the United States pursuant to Form I-9 of the U.S. Department of Justice.

Drug Free/Tobacco Free Policies

The school district is a drug free, tobacco free school and, as such, requires all employees to adhere to specific drug free, tobacco free policies.

I certify that all statements and information provided within this application and its attachments, if any, are true and complete. I understand that omission or misrepresentation of a material fact, or altering this application form, may result in refusal of my application by the District, nullification of a possible offer of employment or termination from employment should the District make an offer of employment to me and later discover any such omission or misrepresentation. By checking the box below, I agree that any misrepresentation, omission of information or alteration of this application form constitutes good cause for termination from employment should the District make an offer of employment to me and later discover such omission or misrepresentation.

Employment Preference Form

Name

Position Applied For

Employment preference allows applicants to claim a preference under the Veterans' Public Employment Preference Act or the Persons with Disabilities Public Employment Preference Act. Applying for a preference is voluntary. All information related to a preference will be kept confidential and used only during the hiring process. Applicants hired by the state will have this information placed in a separate confidential selection file.

Contact your local Job Service Workforce Center for details on veterans' preference. Contact your local Montana Vocational
Rehabilitation Services Office, Department of Public Health and Human Services (DPHHS) for details on obtaining persons with
disabilities preference certification.

To claim Veterans' Employment Preference, you must be a U.S. Citizen and (check one of the boxes below):A Veteran, if: 1. You were separated under honorable conditions, AND you served more than 180 consecutive days of active federal military duty other than for training in the Army, Air Force, Navy, Marines, or Coast Guard or were a member of the reserves who served on federal military duty during a period of war or in a campaign or expedition for which a campaign badge is authorized. 2. You are or were a member of the Montana Army or Air National Guard who satisfactorily completed a minimum of 6 years service in armed forces, the last 3 of which have been served in the Montana Army or Air National Guard.A Disabled Veteran, if: 1. you were separated under honorable conditions from military duty, AND 2. you have an established Armed Forces service-connected disability OR are receiving compensation, disability retirement benefits, or pension from the U.S. Department of Veterans Affairs or military department, OR you have received a Purple Heart.The spouse of a disabled veteran if the veteran's disability prevents him or her from working.The unremarried surviving spouse of a veteran or disabled veteran.The mother of a veteran, if: 1. the veteran died under honorable conditions while serving in the Armed Forces, or the veteran has a service connected, permanent, and total disability, AND 2. your spouse is totally and permanently disabled, OR you are the unremarried widow of the father of the veteran.

To claim Montana Persons with Disabilities Employment Preference, you must be (check one of the boxes below):A person with a disability certified by DPHHSThe spouse of a totally (100%) disabled person certified by DPHHS AND have resided continuously in Montana for at least 1 year immediately before applying for employment.

Check all attachments that you have included to document your eligibility for employment preference (you may upload files at the top of this page):DD-214 showing the character of dischargeDPHHS Disability CertificationService-connected disability letterA document issued by the Office of the Adjutant General of the Montana National Guard certifying service

Signature *Please type your name in place of a written signature

Date *

Notice and Acknowledgment of Process

Pursuant to Montana’s open meetings laws, application materials will likely be reviewed and considered by the Board of Trustees in open session. There are certain recognizable circumstances where individual rights of privacy clearly exceed the merits of public disclosure, thereby allowing the chairperson of the Board of Trustees of a public school to convene in a closed (executive) session should the chairperson make a determination that an individual’s right of privacy clearly outweighs the public’s right to know. If the chairperson of the Board of Trustees convenes in an executive session to review or consider any information obtained during the hiring process, I acknowledge and agree that the Board may engage in discussions about me without my physical presence.

I understand that once my application materials are given to the Board of Trustees, my name may be disclosed to the public upon request. If I am selected as a finalist, my name and other information about my background and qualifications will be disclosed to the public through a press release.

Signature *Please type your name in place of a written signature

Date *