MBAEA Application for Employment - Mississippi Bend AEA

GENERAL INFORMATION

Position Desired(Required)

Date(Required)

Name(Required)

First

Last

Address(Required)

Street Address

City

State / Province / Region

ZIP / Postal Code

Home Phone(Required)

Business Phone

Email Address(Required)

How did you learn of this opening(Required)

Were you ever employed by the Mississippi Bend Area Education Agency?(Required)(Required)

EDUCATION TRAINING

High School

Name(Required)

City(Required)

State(Required)

Degree Earned(Required)

Highest Grade Level Earned?(Required)

Additional Schooling

School Name

City

State

Certificate or Degree Earned

Have you graduated yet?

Date

School Name

City

State

Certificate or Degree Earned

Have you graduated yet?

Date

School Name

City

State

Certificate or Degree Earned

Have you graduated yet?

Date

WORK EXPERIENCE

We will contact your current employer.

Employer(Required)

Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Supervisor(Required)

First

Last

Phone(Required)

Start Date(Required)

End Date

If you are currently employed with this company, please leave this field blank.

Position Held(Required)

Reason for Leaving

EMPLOYMENT REFERENCES

List three references, including particularly persons under whom you have worked. Please provide letters of reference from those persons with your application if you do not have letters in your credentials.

Reference One(Required)

First

Last

Position(Required)

Address(Required)

Street Address

City

State / Province / Region

ZIP / Postal Code

Phone(Required)

Reference Two(Required)

First

Last

Position(Required)

Address(Required)

Street Address

City

State / Province / Region

ZIP / Postal Code

Phone(Required)

Reference Three(Required)

First

Last

Position(Required)

Address(Required)

Street Address

City

State / Province / Region

ZIP / Postal Code

Phone(Required)

BACKGROUND

Are you a U.S. Veteran?(Required)

Have you ever been convicted of, or entered a plea of guilty to any offense other than a minor traffic violation?(Required)

Are you on a sex offender registry?(Required)

Are you on the Department of Human Services’ child registry?(Required)

Have you ever resigned from employment to avoid employer action terminating your employment?(Required)

I have completely reviewed the job description(s) for the position(s) for which I have applied and I am able with or without reasonable accommodations, to fulfill the essential functions of the position(s).(Required)

If there are reasonable accommodations needed, please list the accommodation(s) needed and the function(s) needing accommodation.

DOCUMENT UPLOAD

Upload Document(s)

Drop files here or

Max. file size: 64 MB.

AGREEMENTS

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for on this application is cause for dismissal. I also understand I may be assigned to positions other than that for which I initially made application and that my location of work and/or work hours may be changed. I agree that if employed by the Agency, in consideration for such employment, I shall become familiar with and comply with policies, procedures, and safety practices of the Agency as they exist. I authorize persons, schools, current employer (if applicable) and previous employers and organizations named in this application (accompanying resume, if any) to provide this Agency with any relevant information which may be required to arrive at any employment decision. I understand that a criminal records background check will be completed.

I understand that this application is not a contract of employment and that no hiring is legal until approved by the Mississippi Bend AEA Board of Directors.

Applicant's Signature(Required)

DISCLAIMER: By typing your name, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.