Please Fill Out The Beauregard Parish Head Start Support Application Below
SUPPORT APPLICATION
BEAUREGARD PARISH SCHOOL BOARD, 202 West Third Street / PO DRAWER 938 DeRidder, LA 70634 (337) 463-5551
THE BEAUREGARD PARISH SCHOOL BOARD IS AN EQUAL OPPORTUNITY EMPLOYER. WE ARE DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, CREED, COLOR, AGE, SEX, RELIGION, NATIONAL ORIGIN OR PHYSICAL DEFECTS.
NOTICE TO ALL APPLICANTS: YOUR APPLICATION WILL BE KEPT ON ACTIVE FILE FOR ONE (1) YEAR FROM THE DATE RECEIVED.
PERSONAL DATA
Reaquired field: SOCIAL SECURITY NUMBER:
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Reaquired field: LAST NAME:
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Reaquired field: FIRST
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MIDDLE
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MAIDEN NAME
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Reaquired field: PRESENT MAILING ADDRESS:
Address
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City
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State / Province / Region
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POSITION DESIRED:
PLEASE LIST ALL POSITIONS YOU ARE APPLYING FOR BELOW:
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SCHOOL PREFERENCE
DO YOU HAVE A SCHOOL(S) PREFERENCE? IF SO, LIST ALL PREFERRED SCHOOLS BELOW:
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EDUCATIONAL INFORMATION: HIGH SCHOOL
NAME OF HIGH SCHOOL
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LOCATION OF HIGH SCHOOL
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YEARS ATTENDED
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YEAR GRADUATED
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COURSE OF STUDY
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EDUCATIONAL INFORMATION: College
NAME OF COLLEGE/UNIVERSITY
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LOCATION OF COLLEGE/UNIVERSITY
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YEARS ATTENDED
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YEAR GRADUATED
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COURSE OF STUDY
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EDUCATIONAL INFORMATION: Trade, Business, or Correspondence School
NAME OF SCHOOL
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LOCATION OF SCHOOL
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YEARS ATTENDED
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YEAR GRADUATED
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COURSE OF STUDY
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FORMER EMPLOYERS: List below your last four employers, starting with most recent one first. Give complete addresses.
1. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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NUMBER OF YEARS EMPLOYED
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REASON FOR LEAVING
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2. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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NUMBER OF YEARS EMPLOYED
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REASON FOR LEAVING
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3. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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NUMBER OF YEARS EMPLOYED
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REASON FOR LEAVING
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4. NAME OF FORMER EMPLOYER:
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ADDRESS OF FORMER EMPLOYER:
Address
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City
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State / Province / Region
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NUMBER OF YEARS EMPLOYED
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REASON FOR LEAVING
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REFERENCES: List below the names of three persons (not related to you) whom you have known at least one year, or can attest to your educational experience and background.
1. NAME OF REFERENCE:
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ADDRESS OF REFERENCE:
Address
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City
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State / Province / Region
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2. NAME OF REFERENCE:
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ADDRESS OF REFERENCE:
Address
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City
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State / Province / Region
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3. NAME OF REFERENCE:
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ADDRESS OF REFERENCE:
Address
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City
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State / Province / Region
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IF YES, GIVE OFFENSE, DATE, AND OUTCOME BELOW:
SPECIAL QUALIFICATIONS AND SKILLS: List qualifications and skills you possess which are required for the job for which you are applying, such as a driver's license (type and number), typing and/or shorthand proficiency (speed), ability to operate specialized machinery or equipment, or job related training.
BY SIGNING BELOW, I GIVE MY PERMISSION FOR THE BEAUREGARD PARISH SCHOOL BOARD TO REQUEST EVALUATION RESULTS OF ALL PREVIOUS EMPLOYMENT PERFORMANCE.
Reaquired field: SIGNATURE OF APPLICANT
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BY SIGNING BELOW, I UNDERSTAND THAT IF EMPLOYED: ANY MISREPRESENTATION OR OMISSION OF FACTS REQUESTED IN THIS APPLICATION MAY BE CAUSE FOR DISMISSAL.
Reaquired field: SIGNATURE OF APPLICANT
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If you would like a copy of this form sent to you, fill out the "Email a copy to" section below.
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Required Fields