SCHENECTADY CITY SCHOOL DISTRICT
EMPLOYMENT APPLICATION
108 Education Drive, Schenectady, NY  12303   (518) 370-8100

The Schenectady City School District does not discriminate based on race, creed, religion, gender, age, disability, national origin, veteran or marital status.  An equal opportunity employer.

PERSONAL INFORMATION

Name __________________________________________________________________
Last First Initial Date

Address ______________________________________________________________________
No. & Street City State          Zip Telephone

How long at this address?  (years/months)  ____________________________

Previous Address ______________________________________________________________

No. & Street

City

State

Zip

Social Security #  ____________________________NYS Retirement ___________________

Position Applied For  ___________________________________________________________

How did you find out
about this position?		  _____ Newspaper
 _____ Walk-in		 _____Posting 
_____Other-specify		 ____  Website
_____Word of mouth

Have you ever been an employee of the Schenectady City School District? ____ Yes  _____ No 
If yes, when and in what capacity?
_____________________________________________________________________________________

The Board of Education considers it desirable that staff be residents of Schenectady.  Are you a resident of the City of Schenectady?  ____ Yes   ____ No   If  not, would you make a commitment to move into the City within one year of employment?  ____ Yes   ____ No
 

 
Check appropriate line to the right of each question Yes No

A.  Have you ever resigned from a position rather than face disciplinary action?

_____

_____

B.   Has any disciplinary action been brought against you which resulted in your being discharged from employment?

_____

_____

C.  Did you ever receive a dishonorable discharge from the Armed forces of the United States?

_____

_____

D.  Have you ever been convicted of any crime (felony or misdemeanor)?

_____

_____

E.  Have you ever forteited bail bond posted to guarantee your appearance in court to answer any charges?

_____

_____

F.  Have you ever had a teaching credential revoked, suspended, or annulled?

_____

_____

G.  Have proceedings ever been initiated against you pursuant to New York State Education Law Section 3020a?

_____

_____
 

 

EMPLOYMENT
Begin with present or most recent employer.  If applying for a teaching position, list grade or subject taught, including student teaching experience.  PLEASE NOTE:  This section must be filled out completely.
 Employer                                  Telephone

Dates Employed
From               To

WORK PERFORMED
 Address  
 Job Title  Hourly Rate/Salary
 Starting        Final
 Supervisor
 Reason for Leaving
 
 Employer                                  Telephone

Dates Employed
From               To

WORK PERFORMED
 Address  
 Job Title  Hourly Rate/Salary
 Starting        Final
 Supervisor
 Reason for Leaving
 
 Employer                                  Telephone

Dates Employed
From               To

WORK PERFORMED
 Address  
 Job Title  Hourly Rate/Salary
 Starting        Final
 Supervisor
 Reason for Leaving
 
 Employer                                  Telephone

Dates Employed
From               To

WORK PERFORMED
 Address  
 Job Title  Hourly Rate/Salary
 Starting        Final
 Supervisor
 Reason for Leaving
 
If you need additional space, please continue on a separate sheet of paper.


SPECIAL SKILLS, QUALIFICATIONS AND HONORS

Summarize special skills, qualifications, and honors acquired from employment, education or other experience_______________________________________
_____________________________________________________________
_____________________________________________________________

 

EDUCATION

NAME AND ADDRESS OF HIGH SCHOOL LAST ATTENDED

GRADUATED

YES               NO

TYPE OF DEGREE, DIPLOMA OR CERTIFICATE
     
     
     
     

NAME AND ADDRESS OF ALL COLLEGES, UNIVERSITIES & GRADUATE SCHOOLS

Dates Attended
From       To

  

Graduated

Yes     No

Type of Degree, Diploma or Certificate
     
     
     
     
     
     
     
     

TENURE

Have you ever been granted tenure in New York State?    ___ Yes   ___ No

NAME OF SCHOOL DISTRICT TENURE AREA EFFECTIVE DATE
     
     
     
     

CERTIFICATE/LICENSE

NAME OF CERTIFICATE/LICENSE NUMBER

TYPE I.E.  CQ, TEMPORARY, PROVISIONAL, PERMANENT, ADULT ED.

 DATE ISSUED/STATE
       
       
       
       

REFERENCES

List below three (3) references that have observed your work.  This section must be filled out completely.

Name Address Telephone
     
     
     

List below two (2) personal references, not related to you, who may be contacted.  This section must be filled out completely.
Name Address Telephone
     
     


I hereby declare that the information provided by me is true, factual, and complete.  I understand that false statements will disqualify me for employment or cause my subsequent dismissal.  If employed by the Schenectady City School District, I understand that I will be required to supply additional personal information for the purpose of determining eligibility for benefits and for statistical data.  I voluntarily give the Schenectady City School District the right to investigate my past employment and all statements contained in this application.

Signature:  _________________________________________

Date:  ____________________________________________