Personnel & Human Resources Office

Transcription

1 Personnel & Human Resources Office Dear Applicant: Thank you for your interest in the Mount Vernon School District! It is District policy that we do not accept applications unless you are applying for an open posted vacancy. We always accept applications for substitutes. Please use this application for all classified positions, including substitutes. Additional steps are required to become a substitute; please inquire at the front desk or call for additional assistance. A complete classified application packet includes: Completed District Application indicate posting number on top Letter of Interest responding to the qualifications, listing the Vacancy Number and received during the time the position is open Resume including experience and education Three letters of professional reference Washington State Sexual Disclosure Release Form Copy of high school diploma, transcript or GED equivalent certificate required Verification of two MMR vaccinations OR Lab results indicating IgG titer drawn stating immunity to measles, mumps and rubella required Copy of college/university transcript-unofficial, if available If you already have an application on file in the District, you only need to submit a letter of interest for the posted vacancy during the time the position is open in order to be considered. Please indicate the vacancy name and number on your letter of interest or application and submit in person, by U.S. mail (124 East Lawrence Street, Mount Vernon, WA 98273) or fax to (360) We look forward to your application! 124 East Lawrence Street, Mount Vernon, Washington Telephone: (360) Fax: (360)

2 Mount Vernon School District No An Equal Opportunity Employer Classified Application Form Check the Position(s) Applying For: Substitute (please mark preference below) Cook Custodial Food Service Maintenance Paraeducator Vacancy Number: Last Name: First Name: Initial: Date: Bus Driver Clerical Telephone Number: Address (Street, City, State, Postal Code): Are you a former public school district employee? If so, give name of district, address, telephone number, dates and position: Education: High School*: Graduated GED Additional Education: Degree: *Copy of high school diploma, transcript or GED equivalent certificate required with application. Skills: Typing Skills: Speed Computer Skills: Yes No Models of Computers and Programs: Other Languages That You Read: Write: Speak: Please list training, which you believe valuable in the job for which you are applying. (Give places and dates of experience or training.): Employment: (Begin with present or most recent position) Personal References: (Other than relatives and former employers): Name Address City/State/Zip Telephone #

3 Mount Vernon School District #320 Classified Application Form Applicant Disclosure Form Answer YES or NO to each listed item. If the answer is YES to any item, explain in the area provided, indicating the charge or finding, the date of the conviction or finding, the court(s) involved, and the penalty imposed. I understand that the Mount Vernon School District may inquire of state and federal law enforcement or other agencies and examine court or agency records regarding any criminal history and civil adjudications. 1. Have you ever been convicted of any crime? The term convicted means all adverse dispositions, including a finding of guilty, a plea of guilty or no contest, an Alford plea, stipulation to the facts, a deferred or suspended sentence, or a deferred prosecution. Answer If YES, PLEASE EXPLAIN BELOW. 2. Have you ever had findings made against you for domestic violence, abuse, sexual abuse, neglect, exploitation or financial exploitation of a child or vulnerable adult in any civil adjudicative proceeding? A civil adjudicative proceeding includes a judicial or administrative proceeding as well as findings by the Department of Social and Health Services or the Department of Health that you have not administratively challenged or appealed. Answer: If YES, PLEASE EXPLAIN BELOW. 3. Are you presently charged with, but not convicted of, a crime? Answer: If YES, PLEASE EXPLAIN BELOW. Any misrepresentation or omission of facts shall be sufficient cause for rescission of an offer of employment or termination of employment. Pursuant to RCW 9A , I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Print Name: Date: Signature: Place: Applicant Certification I authorize Mount Vernon School District to make an investigation of my personal, educational, and vocational or employment history. I further authorize any current/former employer, person, firm, corporation, educational or vocational institution, or government agency to provide Mount Vernon School District with information they have regarding me. I hereby release and discharge the Mount Vernon School District and all of those who provide information from any and all liability as a result of furnishing and receiving this information. I further agree that if I am employed, I will provide verification of my certification, education and experience. References and other information that become a part of this application will be regarded as confidential and shall not be returned to me. I certify that all the information contained in this application is true, correct and complete. I agree that if I have provided false, misleading, or incomplete information, the Mount Vernon School District may, in its sole discretion, rescind my offer of employment or terminate my employment. I understand that any offer of employment that may be made to me is conditional and subject to the acceptable outcome of criminal history background information check, and approval of the District s Board of Directors. I also understand that I am financially responsible for any fees related to the clearance and completion of my State and National Background Check and that I will complete this process in a timely manner set forth by the school district. Applicant s Name (please print): Applicant s Signature: Date:

4 Mount Vernon School District #320 Application Form The Mount Vernon School District does not discriminate in employment, programs, or activities on the basis of age, race, color, national origin, creed, religion, sex, sexual orientation, gender expression, gender identity, honorably discharged veteran or military status, or the presence of any sensory, mental or physical disability or use of a trained guide dog or service animal by a person with a disability and provides equal access to the Boy Scouts and other designated youth groups. We will take steps to assure that national origin persons who lack English language skills can participate in all education programs, services and activities, including those specific to career and technical education programming. Inquiries regarding compliance and/or grievance procedures may be directed to the District's Title IX/Civil Rights Compliance Coordinator, Assistant Superintendent William Nutting, bnutting@mvsd320.org or the Section 504/Americans with Disabilities Act Coordinator, Clint Carlton, Director of Special and Support Services, ccarlton@mvsd320.org, 124 E. Lawrence St., Mount Vernon, WA, (360) 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 any other personnel records and data on protected status shall not be in any record that is kept in the applicant s personnel file. Date: Name: Sex: Male Female Age: 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, who maintain tribal affiliation or community attachment, Asian: persons having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent. Black or African (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 cultures or origin regardless of race. Native Hawaiian or Other Pacific Islander: persons having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands. White (not of Hispanic origin): persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.

5 WASHINGTON STATE SEXUAL MISCONDUCT DISCLOSURE RELEASE FAILURE TO SIGN THIS FORM WILL PREVENT EMPLOYMENT OPPORTUNITIES WITH MOUNT VERNON SCHOOL DISTRICT. Please Print Applicant Name (Last, First, Middle) Former Name(s) Prior school district employment in addition to the Mount Vernon School District? Yes No If you checked no, sign and return this form to the Human Resources Department. If you answered yes to the above question, please list below the name and address of the school(s) for which you have been employed. (Attach additional form(s), if necessary.) Please do not forget to sign the form. School/District Name Address Position(s) Held Dates of Employment School/District Name Address Position(s) Held Dates of Employment School/District Name Address Position(s) Held Dates of Employment I authorize you to release to the school/district listed below, all information related to any acts of sexual misconduct that the school district has made a determination that there is sufficient information to conclude that the abuse or misconduct occurred and that the abuse or misconduct resulted in the employee s leaving his/her position at the school district. Such information includes copies of all related documents, including any rebuttal documents, in personnel, investigative or other files, in accordance with RCW 28A.400. I release the above employer and employees acting on behalf of the employer from any liability for providing information described in this document. Applicant Signature Date To: Human Resources Department: The named applicant is under consideration for a position in our district. The Legislature has determined that additional safeguards are necessary in the hiring of school district employees to ensure the safety of Washington s school children. The individual whose name appears above has had previous employment with your organization. As a former employer, we request you provide the information requested on this form within 20 business days as required by state law (RCW 28A.400). Sexual misconduct definitions are found in WAC and WAC Your assistance is appreciated. No sexual misconduct materials were found. Complaint of sexual misconduct Yes, sexual misconduct materials are being forwarded was filed with OSPI. Yes No to the requesting school district. No record of employment Former Employer Signature Title Date Employing School Receipt Date Recipient Name Return all completed information to: Mount Vernon School District Classified Personnel garnold@mvsd320.org 124 E. Lawrence Street Phone: Mount Vernon, WA Fax:

6 MVSD IMMUNIZATION INFORMATION Y N E VERIFIED: Name: Location: The Mount Vernon School District requests the following immunization information. Due to possible outbreaks of communicable diseases in our schools, we need to be able to identify staff that may be susceptible. In the event there is a confirmed case of measles, mumps, rubella or pertussis in our district, we will take direction from the Skagit County Health Department who will determine what is required for staff to continue working during the outbreak. In the past, the Skagit County Health Department has required 2 MMR vaccinations or laboratory verified immunity to measles, mumps and rubella and 1 Tdap vaccination. Please consult your medical provider if you have any questions about what is appropriate for you. MEASLES, MUMPS, RUBELLA(MMR) VACCINATIONS: (Vaccinations must both be received after one year of age and a minimum of 28 days between dose one and dose two) Date of 1 st MMR Vaccination: / / Date of 2 nd MMR Vaccination: / / TITER TEST(S) for MEASLES/MUMPS/RUBELLA: Measles IgG Antibody Date Collected: / / Results: Mumps IgG Antibody Date Collected: / / Results: Rubella IgG Antibody Date Collected: / / Results: Tdap VACCINATION: (A single dose of Tdap is required for people 11 through 64 years of age) Date of Tdap Vaccination: / / PLEASE ATTACH COPY OF DOCUMENTATION TO THIS FORM (appropriate evidence includes immunization records; vaccinations listed on doctor s office stationery; actual lab results from the lab stating immunity levels) EXEMPTION Employees may file an exemption to these immunization requirements by signing below. If a case of measles, mumps, rubella or pertussis are identified in the MVSD and you have filed an exemption, or failed to provide MMR or Tdap information, you will be excluded from work. I am claiming an exemption from these immunizations. I understand that I will be excluded from work if an outbreak is identified in the MVSD district. Signature Date 3/28/17