APPLICATION FOR EMPLOYMENT- SUPPORTPosition applied for:Date MM slash DD slash YYYY Name First Last Sex: Male Female Address 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 PhoneDate of Birth MM slash DD slash YYYY Social Security NumberHave you filed an application here before? Yes No Have you been employed here before? Yes No If yes, give dates: From MM slash DD slash YYYY If yes, give dates: To MM slash DD slash YYYY Are you legally eligible for employment in the country? Yes No (Proof of U.S. Citizenship or immigration status will be required upon employment)Date available for work MM slash DD slash YYYY Would you undergo pre-employment physical? Yes No Type of employment desired Full Time Part Time Substitute check 1 or moreHave you completed high school? Yes No Employment HistoryList past places of employment, most recent firstName of Business/CompanyAddressTelephoneDates Of Employment Add RemovePlease indicate the school(s) in which you will be available: Hardin County High School Hardin County Middle School East Hardin Elementary Northside Elementary Parris South Pickwick Southside West Hardin Elementary Personal References:It is understood and agreed that any misrepresentation by me in this application will be just cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause or prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I give the employer the right to investigate all references and secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. The employer is an equal opportunity employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any consideration for employment on a basis prohibited by local, state, or federal law. I understand that in filling a temporary position I have no expectancy of continued employment but shall be considered for initial employment to fill other vacancies.SignatureDate MM slash DD slash YYYY TITLE IX COORDINATORTitle: Ryan Miller Mailing address: 155 Guinn Street, Savannah, TN 38372 Phone number: 731-925-9037 ext. 2240 Email: ryan.miller@hctnschools.com Hardin County Schools does not discriminate on the basis of sex in any education program or activity. Such non-discrimination is required by Title IX and federal regulations. The requirement not to discriminate extends to admission and employment. Jnquiries about the application of Title IX and its implementing regulations to the district may be refened to the Titl 1 Coordinator, to the Assistant Secretary of Education, or both. Hardin County Schools grievance procedures and grievance process, including: how to report or file a complaint of sex discrjmination; how to report or file a fom1al complaint of sexual harassment, and how the district will respond can be found in Hardin County Board policy 6.3041. Δ Sample Form Name First Last PhoneEmail EmailThis field is for validation purposes and should be left unchanged. Δ
