1.  Lyons Central School 
  1. Application For Support Staff in Lyons Central School
    1. Education
      1. Membership in Professional or Civic Organizations
      2. References
      3. Employment Experience
        1. List most recent experience first
      4. Signature
        1. I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I further acknowledge that any falsification will be sufficient cause for disqualification or dismissal. If employed, I hereby authorize you to make any investigation of my personal history and financial credit record.

 Lyons Central School 


 Lyons Central School  
 9 Lawrence Street
 Lyons, N. Y. 14489
 315-946-4214
 
 
 

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Application For Support Staff in Lyons Central School
 

 
              Date_________________
 
1.   Name________________________________ Social Security No.____________
 
Address ______________________________ Home Phone ________________
 
City __________________________________ Work Phone ________________
 
State _____________________________ Zip ________ County _____________
 
2.   Position Desired _______________________________ Pay Expected _________
 
3.   Date available to begin work ____Type of employment ___Full Time ___Part Time
 
___10 Months ___ 12 Months
 
4.   Civil Service Rating, If any _______________________________________________
 
5.   Have you ever applied for employment with us? _____ If yes: Month and Date ______
 
6.   Are you a Citizen in the United States? _____________________________________
 
7.   Have you ever been convicted of a crime in the past ten years, excluding minor traffic offenses? ___________________________________________________________
 
8.   . Are any criminal charges or proceedings pending against you?
 
If yes to either or both of the above, please explain on a separate sheet.
 
 
 
 
 
 
 
 
 

N.Y.S. Human Rights Law prohibits discrimination because of age, national origin, Race,
Religion, or Sex
 
AN EQUAL OPPORTUNITY EMPLOYER
 

 
 


Education



Education
 
School
Name and Location of School
Course
Of Study
No.
of Years
Completed
Did you Graduate?
Degree or
Diploma
 
 
Elementary
 
 
     
 
Yes
 
No
 
 
 
High
 
 
     
 
Yes
 
No
 
 
 
College
 
 
     
 
Yes
 
No
 
 
 
Other
 
 
 
     
 
Yes
 
No
 		  

 

License(s) Held ________________________________________________Effective Date_____
 
 
 


Membership in Professional or Civic Organizations



Membership in Professional or Civic Organizations

(Exclude those which may disclose your race, color, religion or national origin)
 
 
 

 
 
 
 


References



References
 

(Give references who have first-hand knowledge of your character, scholarship and job ability)
 

1.   __________________________________________________________________________
 
2.   __________________________________________________________________________
 
3.   __________________________________________________________________________
 


Employment Experience



Employment Experience
 


List most recent experience first



List most recent experience first
Name and Address of Employer
Supervisor’s Name and Title
From
From
Reason for leaving
   
Month
Year
Month
Year
 		  
         
     
Annual Salary
 
  Phone ( )      
Describe in detail the work you did  
Name and Address of Employer
Supervisor’s Name and Title
From
From
Reason for leaving
   
Month
Year
Month
Year
 		  
         
     
Annual Salary
 
  Phone ( )      
Describe in detail the work you did  
Name and Address of Employer
Supervisor’s Name and Title
From
From
Reason for leaving
   
Month
Year
Month
Year
 		  
         
     
Annual Salary
 
  Phone ( )      
Describe in detail the work you did  

Indicate employers above you do not wish contacted and why:____________________________
 
 
Have you ever been released or asked to resign from an employment position?
 
Please explain_________________________________________________________________
 


Signature



Signature


I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I further acknowledge that any falsification will be sufficient cause for disqualification or dismissal. If employed, I hereby authorize you to make any investigation of my personal history and financial credit record.



I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I further acknowledge that any falsification will be sufficient cause for disqualification or dismissal. If employed, I hereby authorize you to make any investigation of my personal history and financial credit record.
 
Dated ___________________Signature of Applicant___________________________________
 
 Add by letter and /or resume any additional information that will give us a more complete estimate of you training, experience, character, and ability. Submission of a resume does not relieve you of the responsibility for completing all sections of the official application. Application information should be directed to Lyons Central School District, Business Office, 9 Lawrence Street, Lyons, New York 14489.
 This application will be placed on file, for a period of two years, for consideration when vacancies arise. Should an interview be desired, you will be contacted.
 
 
 
 
 
 

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