Support Staff Application

Bradford Special School District                                                

P. O. Box 220                                                               

Bradford, TN 38316                                                                      

Dan Black, Director of Schools

731-742-3180

 APPLICATION FOR SUPPORT STAFF

 

20____   School Year                                Position Applying for: ________

 

Name _________________________________           SS# ______________________

            Last                   First                        Ml

 

Address _____________________________________            Phone# __________________

City __________________________    State __________      Zip ____________

Date of Birth  _______________ 

 

I. Personal Data:

A. Have you ever been convicted for a crime? _____YES   _____NO

(If YES, please explain)

 ______________________________________________________________________________

______________________________________________________________________________

B. Are you able to perform the essential functions of the job for which you have

applied?     _____YES _____NO

 

II. Education:

School Name/Location Dates Attended Type of Diploma/

Degree/Certificate

 

Elementary _____________________________________________________________

High School College  _______________________________________________________ 

Trade/Other  _____________________________________________________________ 

 

III. Military Service Branch:

Length of Service: Dates: From _________ to _________

 

IV. Work Experience:        (Begin with the most recent)

 Employer                      Address                        Phone               Position Dates Employed

 

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

 

V. Job Skills: (List skills for job in which you have applied) 

                      ________________________________________________________________________

________________________________________________________________________

______________________________________________________________________

 

 VI. Personal References:

 

Name                   Address                        Phone

______________________________________________________

______________________________________________________

_______________________________________________________

________________________________________________________

 

 

I UNDERSTAND THAT ANY OFFER OF EMPLOYMENT IS CONDITIONAL UPON PASSING THE NECESSARY MEDICAL EXAMINATION. ALL
STATEMENTS AND RESPONSES IN THIS APPLICATION ARE TRUE AND EXACT TO THE BEST OF MY KNOWLEDGE.

 

ANY FALSIFICATION OF THIS APPLICATION FOR EMPLOYMENT WILL RESULT IN YOUR IMMEDIATE DISMISSAL.  

 

Name _________________________________________           Date _______________ 

                                  

 

Signature  _____________________________________ 

 

 

Applications arc placed in the active files for the duration of the school year in which the application is filed. It is your responsibility to notify the Personnel Department in wilting if you want your application updated.

 

 It is the policy of the Bradford Special School System not to discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities and provides equal acciess to the Boy Scouts and other designated youth groups.  The following people have been designated to handle inquiries regarding the nondiscrimination policies:

Mr. Jerry Diviney

Federal Programs Director 

731-742-3180

divineyj@k12tn.net

 

Mrs. Amy Dunn

Special Education Director

731-742-3180 

dunna@k12tn.net

 

 

 

 

 

3/20/201