Grant Parish School Board – General Employment Application Official application for non-instructional and support positions. Δ Step 1 of 6 16% APPLICANT DETAILSName(Required) First Last Date of Application(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell Phone(Required)Email(Required) Position(s) Applied For(Required) Bookkeeping Secretary/Receptionist Paraprofessional Maintenance Custodian Mechanic/Bus Shop Cafeteria Worker Nurse Bus Driver Bus Attendant Other If Other, please specify(Required)Location(s) / School(s) Applied For(Required) Georgetown High Grant High Grant Junior High Montgomery High Pollock Elementary South Grant Elementary Verda Elementary Transportation Department Select the school(s) or department for which you are applying. Transportation applicants should select Transportation Department.EMPLOYMENT & RETIREMENT STATUSHave you ever worked for the Grant Parish School Board before?(Required) Yes No If yes, when and what position?(Required)Are you a Retiree returning to work?(Required) Yes No Retirement Date(Required) MM slash DD slash YYYY Retirement System(Required) PERSONAL INFORMATIONAre you eligible to work in the United States?(Required) Yes No Have you ever been convicted or pleaded no contest to a felony?(Required) Yes No If yes, please explain:(Required)Have you ever been convicted of a misdemeanor involving illegal conduct with a minor or for a drug offense?(Required) Yes No If yes, please explain:(Required)LOUISIANA ETHICS CODECertain provisions of the Louisiana Ethics Code govern employment and personnel matters. For instance, the Ethics Code restricts the positions that may be filled by an immediate family member of the superintendent and school board members. La. R.S. 42: 1102(13) provides that an immediate family member of a superintendent or board member includes “his children, the spouses of his children, his brothers and their spouses, his sisters and their spouses, his parents, his spouse, and the parents of his spouse.”Accordingly, are you an immediate family member of the superintendent or any school board member?(Required) Yes No If yes, please provide the name, relationship, and position of the superintendent or school board member.(Required) EDUCATIONName & Address of High School AttendedHighest Grade CompletedGraduation Date MM slash DD slash YYYY Name & Address of College AttendedDo you have a degree from an accredited university?(Required) Yes No Provide copy of degreeAccepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 10 MB. Optional upload. You may also mail or deliver documentation if preferred.ADDITIONAL QUALIFICATIONSOther Skills and Qualifications: Licenses, Trainings, Awards, etc. PRESENT OR PREVIOUS EMPLOYMENTCurrent or Most Recent Employer NameCurrent or Most Recent Employer PhoneCurrent or Most Recent Employer AddressCurrent or Most Recent Position/TitleCurrent or Most Recent Employed From MM slash DD slash YYYY Current or Most Recent Employed To MM slash DD slash YYYY Current or Most Recent Responsibilities & Job DutiesCurrent or Most Recent Reason For LeavingPRIOR EMPLOYMENTPrevious Employer NamePrevious Employer PhonePrevious Employer AddressPrevious Position/TitlePrevious Employed From MM slash DD slash YYYY Previous Employed To MM slash DD slash YYYY Previous Responsibilities & Job DutiesPrevious Reason For Leaving PROFESSIONAL REFERENCESPlease provide Name, Title, and Phone Number for three references.Reference 1 (Name / Title / Phone)Reference 2 (Name / Title / Phone)Reference 3 (Name / Title / Phone) EMPLOYMENT DISCLOSURESHave you ever been terminated by a school system, resigned prior to the expiration of your contract, or asked to resign?(Required) Yes No If so, please explain (identifying the employer, basis for termination/resignation, and date):(Required)Have you ever been convicted, pled guilty, or no contest to a felony or other serious offense?(Required) Yes No If so, please explain (identifying the charge, jurisdiction and court, date of conviction/plea, and factual basis):(Required)Have you ever engaged in or been accused of engaging in sexual misconduct with a minor/student or the abuse or neglect of a minor?(Required) Yes No If so, please explain (identifying conduct, dates, employer, criminal charges, jurisdiction/court, date of conviction/plea, and factual basis):(Required)Have you been the subject of any investigation of alleged sexual misconduct involving a minor or student, abuse of a minor or student or neglect of a minor or student?(Required) Yes No If so, please explain (identifying conduct, dates, employer, results of investigation, criminal charges, jurisdiction/court, date of conviction/plea, and factual basis):(Required)AUTHORIZATION AND RELEASELouisiana Revised Statutes 17:3884 provides that a school board considering the employment application of a person who has been evaluated in another school system shall request such person’s evaluation results as part of the application process and shall inform the applicant that his/her evaluation results will be requested. The applicant shall be given the opportunity to review any information received by the prospective employer as a result of such request and to provide any response or information the applicant deems appropriate. Please be advised, therefore, that the Grant Parish School Board will request evaluation results on you from each of the school districts you have listed in your application. You will be given an opportunity to review the evaluation results received and to provide a response or information if you would like to do so. Any written response or information you might provide will be retained with your application. Louisiana Revised Statutes 17:15 also requires all applicants for employment to be fingerprinted in order to assist in background checks of those individuals. Should it be determined that any applicant (or employee) has been convicted of one or more of the criminal offenses set forth in Louisiana Revised Statutes 17:587.1(C), then that applicant (or employee) is generally precluded from further employment with the school system. Louisiana Revised Statutes 17:81.9 further requires a school board receiving an application to request that all current and prior school board employers of the applicant provide it with all information in their records relative to instances of sexual misconduct with students committed by the applicant (if any). This law further provides that the applicant must release all such employers from liability arising from the release of such information to the prospective employer.I certify that the information which I have provided in the attached application is true and complete. I understand that furnishing false information or omitting information on this application could disqualify me from consideration for employment or could lead to my discharge from employment. I hereby authorize the Grant Parish School Board to request, receive, and review my prior evaluations and information relative to sexual misconduct with students (if any) from all of my current or previous school system employers. I further release the Grant Parish School Board and all current and former employers, their agents and employees from any liability connected with such disclosures and do hereby specifically authorize such employer(s) to release to the Grant Parish School Board such information and documentation as may be requested in connection with my application for employment with it.Digital Signature (Full Name)(Required)Date signed(Required) MM slash DD slash YYYY
