Submit completed application to the school’s Band Director.
Rowan-Salisbury School System Non-Faculty Band Camp Application
Please complete all information on both pages of this application.
Personal Information
Name _______________________________________________________________________________________________
Preferred Title
First
Middle/Maiden
Last
Nickname
Address_____________________________________________________________________________
City _____________________________________ State ___________ Zip Code ________________
Home Phone No. _________________________
Alternate Phone No. __________________________
E-Mail Address __________________________________________ [ ] Former Employee
Preferences in Non-Faculty Band Camp
School Year ______________
School ________________________________________________
Band Camp Activity: _____________________________________________
Work Experience
Dates
From-To
(Mo/Yr)
/
/
1.
/
-
/
2.
/
-
/
3.
/
-
/
4.
Name of School/Organization/Employer
Location of School/
Organization/Employer
Duties
References
Please list at least three references that have first-hand knowledge of your professional ability, experience, and competence. Please
include names of your current and last employers. References from relatives or persons who can only evaluate your personality
and character are not acceptable.
Name
Position
Telephone Number(s)
Mailing Address
1.
2.
3.
Revised 4/20/15
Additional Information
Please Check Appropriate Answer:
Yes
[ ]
[ ]
[ ]
[ ]
No
[ ]
[ ]
[ ]
[ ]
Have you ever been suspended, dismissed, fired, or discharged from a position of employment?
Have you ever been subject to disciplinary action during a period of employment?
Have you ever been asked to resign from a position of employment?
Have you ever been convicted or pleaded nolo contendere (no contest) to any violation of the law other than a minor
traffic ticket?
[ ] [ ] Do you have any criminal charges or procedures pending?
If your answer to any of the above question is yes, please explain below or attach a separate sheet.
Applicant’s Statement
I, the applicant/employee hereby expressly authorize the Board of Education, its agents, and its employees to make any investigation of my
personal or employment history, expressly including, but not limited to, federal and/or state criminal, law enforcement, or traffic records, which
may include confirmation by fingerprint identification. I further authorize any former employer, person, firm, corporation, credit agency,
administration body, or governmental agency to give the Board of Education, or its agents, or its employees any information they may have
regarding me. I hereby release the Rowan-Salisbury School Board of Education to which this application is submitted and any and all providers
of information to whom this release is sent, from any liability as a result of furnishing or receiving this information.
I have read the information contained in the application carefully and certify that the information I have given is correct and complete. I
understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal
I understand that, if approved, I will be assisting on a volunteer basis. I also understand that a criminal background check and checks of state and
national sex offender registries are required prior to my approval for this position. My time and service in this capacity are given without
promise, expectation or receipt of any form of compensation, benefits or other remuneration for this service. Any receipt of compensation,
benefits or other remuneration for this service will be considered a nominal fee. I will follow all policies of the Rowan-Salisbury Schools in the
completion of my duties. I understand that my participation as a volunteer may be terminated at any time, without cause, and that I may
withdraw from participation at any time for any reason.
Applicant’s Signature
Date
Principal Approval
I verify that the above named applicant has been informed of the policies of the Rowan-Salisbury Schools.
I recommend this applicant for the band camp activity __________________________________ for the ___________ school year,
beginning on: ___________________________ and ending on ___________________________.
Volunteer-Stipend amount $______________ (not to exceed $500)
Principal’s Signature ______________________________________
Date _________________________
The Rowan-Salisbury School System is an equal opportunity and does not discriminate on the basis of race, color, gender, religion, age, or handicapping condition.
FOR CENTRAL OFFICE USE ONLY
[ ] Background Check Cleared
ID ______________________
Start Date ________________________
Approved: HR _____________________________ Date: ___________________
Total: $_______________ EOM: August September November
Budget Code: 2.5502.801.192
Revised 04/20/15