Ferndale School District Application! ! Thank you for your interest in working for our school district. This application is good for most nonteaching posted positions, including Para-Educator, Custodial, Clerical, Food Service, Bus Driver, Translators, etc. The school district accepts applications for regular, continuing or temporary positions only when job openings are available. ! ! !"#$%#&'()#*&&+,&-(.&/0%1&)(&2#&$&%.2%)0).)#&03&(.4&50%)406)&-(.&7.%)&,0""&(.)&)1#& !"#$%&%"%'()**+&,-%&./(*-,0'%&$35&,(""(/&)1#&(.)"03#5&03%)4.6)0(3%&0)&6(3)$03%8! ! APPLYING FOR A REGULAR or TEMPORARY POSITION:! ! Complete the attached classified application if you are interested in applying for a full-time or parttime regular or temporary position. This application must be accompanied by a letter of interest addressed to the person named in the job posting and an up-to-date resume. If you are hired in any capacity there will be additional paperwork, including fingerprint background check, payroll paperwork, etc. ! ! ! ! All application paperwork must be received at the district office located at 6041 Vista Dr. Ferndale WA. 98248. A copy will be kept on file at the district office for one year. Applications will be copied and forwarded to the appropriate department for consideration. You are encouraged to follow up with the appropriate department(s) regarding the status of your application. ! "#!$%&!'()*!(+$!,&*-./%+-!01*(-*!2%+.(2.!3*44/!3/15%4*6!71(--/#/*8!9&5(+!:*-%&42*-! ! ;<=>?!<@<ABC>C!%4!D*44/ED/15%4*F#*4+8(1*-8E%4D! ! FERNDALE SCHOOL DISTRICT #502 P.O. Box 698, 6041 Vista Drive Ferndale, WA 98248 ATTN: Classified Personnel Position Applying For _____________________ Please check all that apply! Full - Time Bus Driver Custodial Maint. Grounds Maint. Food Service (360) 383-9232 Yes / No Part-Time Yes / No Substitute / On-Call Yes / No Secretary Para-Educator PERSONAL DATA Name Date of Application Last First Middle Address Home Phone ( ) Alternate Phone ( ) Street City State Zip Social Security # Email: -- -- EXPERIENCE WITH COMMUNITY AND YOUTH GROUPS REFERENCES List references, excluding relatives, who may be contacted Name Equal Opportunity Employer Street Address, City, State, Zip Telephone Occupation Page 1 EXPERIENCE List your most recent employment first. If additional space is needed, attach a separate sheet of paper. May we contact the employers listed below? YES / NO If not, indicate which one(s) you do not wish us to contact. Month & Year From To Employer / Address Equal Opportunity Employer Position Held/Duties Reason for Leaving Supervisor(s) Name / Phone No. Page 2 EDUCATION Name of High School Location Did you Graduate? Yes G.P.A. No College or University Location Dates Degree Major Other Education Location Dates Degree Major OTHER Are you able to perform the duties and tasks of the position for which you are applying with or without reasonable accommodation or assistance? With accommodation or assistance Without accommodation or If accommodation or assistance would be required, please explain how you would perform the duties and tasks, and with what accommodation. During the past seven years, have you been convicted of any crime or been released from prison? _______ If yes, please describe fully. An affirmative answer does not necessarily disqualify you from employment. Equal Opportunity Employer Page 3 CUSTODIAL / MAINTENANCE SKILLS Skill YES NO Degree of Proficiency Plumbing Electrical Control Technician Carpentry Custodial OTHER List the area(s) for which you have a journeyman rating: GROUNDS MAINTENANCE SKILLS Skill YES NO Degree of Proficiency Lawn Care Pruning Control Spraying Landscaping Equipment Maintenance OTHER List the area(s) for which you have a journeyman rating: PARA - EDUCATOR SKILLS / ACCOMPLISHMENTS Skill YES State Core Competency Requirements met? (test or associates degree) AA Degree Earned? Experience working with special needs/troubled youth? Training in De-Escalation/Anger Management? Academic mentoring/tutoring (specify subject and levels)? Experience supervising youth in a classroom or playground activities? NO Degree of Proficiency / Experience OTHER Equal Opportunity Employer Page 4 LICENSES / CERTIFICATES Type of License / Certificate YES NO Expiration Date Endorsements Washington State School Bus Drivers' Certificate Specify date of most recent bus driver in-service course DATE ___________ LOCATION __________________ List any moving violations in the last three years Have you taken the Bellingham Vocational Technical Institute's Bus Driver course? LOCATION _________________ Valid First Aid Card Washington State Driver's License Food Handlers' Permit OTHER OFFICE / CLERICAL / ACCOUNTING SKILLS Skill YES NO Degree of Proficiency Keyboard Speed w.p.m. ____________ Shorthand / Transcription &RPSXWHUVDQG%UDQG0DF3&« Word processor (and Brand) Database and Spreadsheets (and Brand) Other Software Used (please specify) 10 Key (by sight or touch?) Sight Touch Fax Machine Copy Machine Multi-Line Telephones Customer Service Are you more comfortable in slow or fast paced environments? Do you work better alone or on a team? Supervised or Unsupervised? OTHER Equal Opportunity Employer Page 5 PERSONAL GOALS In the spaces below, please state why you desire employment with the Ferndale School District and any other skills/qualifications not listed above that you bring to this position. NOTICE Pursuant to Chapter 486, Laws of 1987, an inquiry will be made to the Washington State Patrol or a Federal law enforcement agency to determine whether a perspective employee has been (1)(a) convicted of any offense against persons; (b) found in any dependency action under RCW 13.34.030; (c) to have sexually assaulted or exploited any minor or to have physically abused any minor; or (d) found in any disciplinary board final decision. Any response received from the Washington State Patrol or a Federal law enforcement agency pursuant to such inquiry will be made available to the individual. I certify that the information listed on the application is accurate and true. Further, I understand the district will request a background check for perspective employees through the Washington State Patrol and FBI pursuant to Chapter 486, Laws of 1987. Date Signature Ferndale School District complies with all state and federal rules and regulations and does not discriminate on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained guide dog or service animal and provides equal access to the Boy Scouts and other designated youth groups. This holds true for all district employment opportunities. Equal Opportunity Employer Page 6 Ferndale School District No. 502 Optional Confidential EEO Data Form The Ferndale School District complies with all state and federal rules and regulations and does not discriminate on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained guide dog or service animal and provides equal access to the Boy Scouts and other designated youth groups except as may be necessary to meet a bona fide occupational qualification. The District is an equal opportunity employer, supports the spirit, policies, and practices of affirmative action, and has implemented programs to address the diversity of its workforce. A response to the following questions will assist the District in accurately reporting its employment practices to state and federal agencies and complying with the District's affirmative action plan. Providing this information is strictly voluntary and it shall be maintained as confidential. The completed data form will be kept separate from other personnel records, and data on protected status shall not be recorded on any record that is kept in an employee or applicant's personnel file. Date: ____________________________ Name: _______________________________________________________________________ Position Applied For: __________________________________________________________ Sex: Female Male Race/Ethnicity: The current legal definition of each racial/ethnic group is provided below. American Indian or Alaskan Native: persons having origins in any of the original peoples of North, Central, or South America and who maintain tribal affiliation or community attachment. Asian or Pacific Islander: persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. Black or African-American (not of Hispanic origin): persons having origins in any of the Black racial groups of Africa. Hispanic or Latino: persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. White (not of Hispanic origin): persons having origins in any of the original peoples of Europe, the Middle East, or North Africa. February, 14 FERNDALE SCHOOL DI STRI CT NO.502 Ferndale, Washington AUTHORI ZATI ON TO CHECK WORK HI STORY I authorize Ferndale School District to check my references and to investigate any information provided in my application for employment. I further authorize my past employers or anyone with information about my work history, education or qualifications to provide such information to Ferndale School District in response to their inquiry. I agree to hold harmless from any liability (suit, claim or other action) anyone supplying such information to Ferndale School District. Should I become employed by Ferndale School District and at some future time leave said employment, my signature below further authorizes Ferndale School District to release information regarding my performance to any potential future employer. Signed: (Applicant Name Printed or Typed) Date Ferndale School District No. 502 PO Box 698 Ferndale, WA 98248 (360) 383-9206 Fax (360) 383-9201 PRE-EMPLOYMENT BACKGROUND QUESTIONNAIRE Please complete the following questions and sign the declaration. Any falsification or deliberate misrepresentation, including omission of a material fact or failure to complete any part of your application or this questionnaire can be grounds for denial of employment or continued employment with the Ferndale School District. ALL REQUIRED DOCUMENTATION REQUESTED BELOW MUST ACCOMPANY THIS FORM. ALL QUESTIONS MUST BE ANSWERED. IF ADDITIONAL SPACE IS NEEDED, ATTACH A SEPARATE SHEET OF PAPER. SECTION I – PERSONAL INFORMATION (please print or type) 1. NAME: 2. ADDRESS: (Complete mailing address) 3. TELEPHONE: 4. Please list all former names (a) you have used when working for another employer, or (b) by which you are known to reference. If you have more than three, list them on a separate sheet of paper. ( ) Business ( ) Home SECTION II – PROFESSIONAL FITNESS (If you answer "yes" to questions 1 through 4, on a separate sheet of paper, give a complete explanation, including duties, circumstances, and any supporting documentation. Yes No 1. Have you ever been dismissed, discharged or fired from any employment? 2. Have you ever resigned from or otherwise left any employment while allegations of misconduct on your part were pending or under investigation? 3. Have you ever been disciplined by a past or present employer because of allegations of misconduct? 4. Are you currently or have you ever been the subject of any investigation or inquiry by an employer because of allegations of misconduct on your part? SECTION III – CRIMINAL HISTORY Yes No 1. 2. Have you ever been convicted of any crime? (Note: For the purpose of this question "convicted" includes (a) all instances in which a plea of guilty or nolo contendere is the basis of conviction, and (b) all proceeding in which a sentence has been suspended or deferred.) You need not list traffic violations for which a fine or forfeiture of less than $150.00 was imposed. a. Do you currently have any outstanding criminal charges or warrants of arrest pending against you in Washington? b. Do you currently have any outstanding criminal charges or warrants of arrest pending against you in any other state, province, territory, and/or country? If you answered "yes" to questions l or 2 of Section Ill, please provide the following: a. b. c. d e. f. g. A detailed statement including what occurred, the nature of the offense, charge or warrant; The name and address of the arresting agency; The date of the arrest; The final disposition, if any; If a court was involved, the name and address of the court; The complete arrest report and sentence and judgment; and A complete driving abstract for five years if the arrest was driving related. Yes No 3. Are you presently under in investigation in any jurisdiction for possible criminal charges? If your answer is "yes", identify agency and location (street address, city, and state). A “yes” answer to questions 1 through 3 above will not necessarily bar you from employment. SECTION IV - FITNESS Yes No 1. Are you able to perform the essential functions of the certificated/classified position(s) for which you have applied with or without reasonable accommodation? 2. Do you currently use illegal drugs? 3. Have you used illegal drugs in the last year? If your answer is “yes”, explain on a separate sheet of paper. 4. Have you ever been found in any dependency or domestic relations matter to have sexually assaulted or exploited any minor? 5. Have you ever been found in any dependency or domestic relations matter to have physically abused any person? If you answered "yes" to questions 3 or 4, attach copies of any court orders entered in the above proceeding. DECLARATION I, certify (or declare) under the penalty of perjury under the laws of the State of Washington that the foregoing and all information included in the application is true and correct. If the information provided or answer(s) to any question on the application or the eEmployment Background Questionnaire change prior to my being hired, I understand at I must immediately notify the Ferndale School District. I understand I must answer this application truthfully and completely. 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