Beauregard Parish School Board

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Instructions: Please fill out the following support employment application. If you would like a copy of this form sent to your email address, fill out the “Send A Copy To” section at the bottom of the form. Applicants are urged to consider carefully and understand fully each question and to type the response in the proper blanks. All information submitted is subject to verification.

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.

NOTE: PLEASE ATTACH A COPY OF ANY CERTIFICATE, RESUME, TRANSCRIPT, OR DIPLOMA WHICH VERIFIES EDUCATION. APPLICATION IS NOT CONSIDERED COMPLETE WITHOUT THIS INFORMATION.

Upload

DATE OF APPLICATION:

PERSONAL DATA

SOCIAL SECURITY NUMBER:

DATE OF BIRTH

LAST NAME:

FIRST

MIDDLE

MAIDEN NAME

Reaquired field:

PRESENT MAILING ADDRESS:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

EMAIL ADDRESS

PHONE NUMBER

ARE YOU A MEMBER OF TEACHER'S RETIREMENT SYSTEM OF LOUISIANA?

YES, ACTIVE

YES, RETIRED

IF RETIRED, ARE YOU IN:

REGULAR

DROP

DISABILITY RETIRED

ARE YOU A MEMBER OF SCHOOL EMPLOYEES' RETIREMENT OF LOUISIANA?

YES, ACTIVE

YES, RETIRED

IF RETIRED, ARE YOU IN:

REGULAR

DROP

DISABILITY RETIRED

POSITION DESIRED:

EMPLOYMENT DESIRED:

BUS OPERATOR

FOOD SERVICE

CUSTODIAL

CO-TEACHER

CLERICAL

TECHNOLOGY

Other

PLEASE LIST ALL POSITIONS YOU ARE APPLYING FOR BELOW:

SCHOOL PREFERENCE

DO YOU HAVE A SCHOOL(S) PREFERENCE? IF SO, LIST ALL PREFERRED SCHOOLS BELOW:

DATE AVAILABLE TO START

HAVE YOU WORKED FOR BEAUREGARD PARISH BEFORE THIS DATE?

YES

EDUCATIONAL INFORMATION: HIGH SCHOOL

NAME OF HIGH SCHOOL

LOCATION OF HIGH SCHOOL

YEARS ATTENDED

YEAR GRADUATED

COURSE OF STUDY

EDUCATIONAL INFORMATION: College

NAME OF COLLEGE/UNIVERSITY

LOCATION OF COLLEGE/UNIVERSITY

YEARS ATTENDED

YEAR GRADUATED

COURSE OF STUDY

EDUCATIONAL INFORMATION: Trade, Business, or Correspondence School

NAME OF SCHOOL

LOCATION OF SCHOOL

YEARS ATTENDED

YEAR GRADUATED

COURSE OF STUDY

FORMER EMPLOYERS: List below your last four employers, starting with most recent one first. Give complete addresses.

1. NAME OF FORMER EMPLOYER:

ADDRESS OF FORMER EMPLOYER:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

PHONE NUMBER (INCLUDING AREA CODE)

STARTING DATE

ENDING DATE

NUMBER OF YEARS EMPLOYED

POSITION

REASON FOR LEAVING

2. NAME OF FORMER EMPLOYER:

ADDRESS OF FORMER EMPLOYER:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

PHONE NUMBER (INCLUDING AREA CODE)

STARTING DATE Copy

ENDING DATE

NUMBER OF YEARS EMPLOYED

POSITION

REASON FOR LEAVING

3. NAME OF FORMER EMPLOYER:

ADDRESS OF FORMER EMPLOYER:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

PHONE NUMBER (INCLUDING AREA CODE)

STARTING DATE

ENDING DATE

NUMBER OF YEARS EMPLOYED

POSITION

REASON FOR LEAVING

4. NAME OF FORMER EMPLOYER:

ADDRESS OF FORMER EMPLOYER:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

PHONE NUMBER (INCLUDING AREA CODE)

STARTING DATE

ENDING DATE

NUMBER OF YEARS EMPLOYED

POSITION

REASON FOR LEAVING

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:

ADDRESS OF REFERENCE:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

PHONE NUMBER OF REFERENCE

RELATIONSHIP

2. NAME OF REFERENCE:

ADDRESS OF REFERENCE:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

PHONE NUMBER OF REFERENCE

RELATIONSHIP:

3. NAME OF REFERENCE:

ADDRESS OF REFERENCE:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

PHONE NUMBER OF REFERENCE:

RELATIONSHIP

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

YES

IF YES, GIVE OFFENSE, DATE, AND OUTCOME BELOW:

DO YOU HAVE A RELATIVE WHO IS A BOARD MEMBER/SUPERINTENDENT DEFINED AS CHILDREN, SPOUSES OF CHILDREN, BROTHERS, SISTERS, PARENTS, SPOUSE, AND THE PARENTS OF A SPOUSE?

YES

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.

SIGNATURE OF APPLICANT

BY SIGNING BELOW, I UNDERSTAND THAT IF EMPLOYED: ANY MISREPRESENTATION OR OMISSION OF FACTS REQUESTED IN THIS APPLICATION MAY BE CAUSE FOR DISMISSAL.

SIGNATURE OF APPLICANT

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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