Employment Application

Required

Salisbury School is an equal opportunity employer and does not discriminate in any phase of employment or any terms and conditions of employment. Completion of this application does not constitute an offer of employment. The School is an at-will employer, meaning either the School or an employee can terminate the employment relationship at any time for any reason, with or without cause. By completing and signing this application, applicants authorize the School to investigate the veracity of any and all information herein and further release and indemnify the School from any and all liability associated with such investigation. If the duties of a hired applicant will include driving students in school vehicles, the hiree may be subject to annual drug testing on a random basis, as required by state law.
In the event you are hired, this application will become part of your personnel file. Otherwise the application will be retained on file for a period of one year from the date of the employment decision. This application must be fully completed and signed for further consideration. Resumes may be included, but are not a substitute for completion of this form.

Applicant Information

Date:

Must contain a date in M/D/YYYY format

Name:required

First Name

Middle (optional)

Last Name

Phone:required

Email Address:required

Address:

How long at this address?

Position Applying For:required

Previous Addresses (If at current address for less than 5 years):

Date you can start:

Must contain a date in M/D/YYYY format

Salary Expectation:required

Are you employed now?

Yes

If so, may we inquire about your present employer?

Yes

Present Employer Name and Phone Number

If yes, where?

Have you ever worked at Salisbury School?

Yes

If yes, when and why did your employment end?

Are you currently subject to a non-compete, non-solicitation, employment agreement or any other obligation with a party that could restrict, in any way, your ability to work for the School or your ability to perform the job for which you are applying for?

Yes

If yes, provide documentation with your application:

Referral Source:

School Website

School Employee

Other

Other source:

Education

High School:

Address- High School:

How many years did you attend High School?

Did you graduate High School?

Yes

High School Degree:

College:

Address- College:

How many years did you attend College?

Did you graduate College?

Yes

College Degree:

Other:

Address- Other:

How many years did you attend Other?

Did you graduate Other?

Yes

Other Degree:

References

Please provide the name of three persons not related to you, whom you have known for at least one year.

1. Full Name and Company:

1. Relationship:

1. Address and Phone:

2. Full Name and Company:

2. Relationship:

2. Address and Phone:

3. Full Name and Company:

3. Relationship:

3. Address and Phone:

Previous Employment

Please start with your present or most recent employer. Applicants must include a full employment history, including unpaid or volunteer employment, that involved contact with children. Do not omit periods of employment. You must complete this section even if you are submitting a resume.

1. Employer:

1. Employer Address and Phone:

1. Job Title and Responsibilites:

1. Supervisor:

1. Did this position involve contact with children?

Yes

1. Start and end dates:

1. Reason for leaving:

2. Employer:

2. Employer Address and Phone:

2. Job Title and Responsibilities:

2. Supervisor:

2. Did this position involve contact with children?

Yes

2. Start and end dates:

2. Reason for leaving:

3. Employer:

3. Employer Address and Phone:

3. Job Title and Responsibilities:

3. Supervisor:

3. Did this position involve contact with children?

Yes

3. Start and end dates:

3. Reason for leaving:

Military Service

Branch:

Number of Years Served:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Background and Criminal History

1. Have you ever been convicted of a crime, or are criminal charges pending against you?

Yes

If yes, please provide details of such conviction or pending charges :

2. Have you ever been employed by a local or regional board of education, a private school, a governing council of a state or local charter school, an interdistrict magnet school operator or other employment (including unpaid or volunteer employment) that caused you to have contact with children?

Yes

3. Have you ever been the subject of an abuse or neglect or sexual misconduct investigation by any employer, state agency or municipal police department, unless the investigation resulted in a finding that all allegations were unsubstantiated?

Yes

If yes, please provide specific details of such investigation including dates:

4. Have you ever been disciplined or asked to resign from employment or resigned from or otherwise separated from any employment while an allegation of abuse or neglect was pending or under investigation by the Department of Children and Families (or its equivalent), or an allegation of sexual misconduct was pending or under investigation or due to an allegation substantiated pursuant to C.G. S. section 17a101g of abuse or neglect, or of sexual misconduct or a conviction for abuse or neglect or sexual misconduct?

Yes

If yes, please provide specific details of the incident(s):

5. Have you ever had a professional or occupational license or certificate suspended or revoked or have you ever surrendered such a license or certificate while an allegation of abuse or neglect was pending or under investigation by the Department of Children and Families (or its equivalent), or an investigation of sexual misconduct was pending or under investigation, or due to an allegation substantiated by the Department of Children and Families (or its equivalent) of abuse or neglect or of sexual misconduct or a conviction for abuse or neglect or sexual misconduct?

Yes

If yes, please provide specific details of the incident(s):

6. Have you ever been involuntarily terminated from your employment or a voluntary position?

Yes

Which employer(s)?

If yes, please explain the circumstances of such involuntary termination:

7. Is there a reason any past employer would give you a negative reference?

Yes

If yes, who and why?

8. Have you ever been disciplined or discharged by an employer for making threats, fighting, or participating in any incidents involving violence?

Yes

If yes, please provide the approximate dates and a description of the incident:

Certification, Consent and Release

I certify that I have completed this application (including attachments) and that my answers are true, accurate and complete, to the best of my knowledge. I understand and agree that providing false or misleading information or significant omissions will disqualify me from further consideration for employment and will be cause for my immediate termination if discovered at a later date. Further, I understand and agree that employment with the School is for no definite period and may be terminated at any time without prior notice, with or without cause. required

I agree

In connection with my application for employment, I authorize and consent to the School investigating all statements contained in this application for employment including information from my past and current employers and schools attended. I expressly give my consent and authorize past and current employers, law enforcement agencies, governmental agencies, references, and academic institutions to provide any information regarding my background and suitability for employment at the School. This includes, my job performance, appraisals/evaluations, wage history, disciplinary action(s) if any, and all other matters pertaining to my employment history and academic credentials. required

I agree

I further consent to the disclosure of any and all information about me contained in private and governmental files relative to this application for employment or relating to my present and former employment history, and I request all former employers and federal, state and local governmental and law enforcement agencies to supply such information to the School. The School is also authorized to make any investigation of my personal history, driving history, sexual offender registry, criminal and civil court history, and financial and credit record through any investigative or credit agencies or bureaus of its choice. required

I agree

I voluntarily and knowingly release all former and current employers, law enforcement agencies, governmental agencies, references, academic institutions and the School from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with the School. I waive all rights to bring any action for defamation, invasion of privacy, or similar causes of action against the School, any individual, law enforcement, governmental, or business entity providing or seeking such information. required

I agree

I understand that upon receiving a conditional offer of hire from the School, I will be required to and hereby consent to submit to an extensive background check, including, but not limited to, a check of the Department of Children and Families abuse and neglect registry, a state and national criminal history records check, and the Connecticut Department of Education records. Such background check also may include a credit check if applicable to the position and possibly a drug test and medical examination (based on the position) prior to actual employment. I understand that all such background checks referenced herein are a condition of my employment. required

I agree

I authorize the School, its agents, and employees to provide my employment record or information obtained during the course of the investigation of me in connection with my application for employment at the School, in whole, or in part, to any prospective employer, governmental agency, or other party with a proper and appropriate interest. I voluntarily and knowingly release the School, its agents, and employees from any and all liability arising from their providing such information to any prospective employer, governmental agency, or other party with a proper and appropriate interest and waive all rights to bring any action for defamation, invasion of privacy, or similar causes of action against the School, any individual, law enforcement, governmental, or business entity providing or seeking such information. required

I agree

By typing your name below you certify that the information contained in this employment application is true and complete to the best of your knowledge.required