Scotland Elementary School
Office of the Superintendent of Schools
68 Brook Road, Scotland, CT 06264
APPLICATION FOR EMPLOYMENT
Employment Application Procedure
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Complete all applicable sections of the application
Type or print in ink all requested information
Sign and date the application
Attach a letter of interest, resume, and three letters of reference.
Attach copies of certifications (if applicable)
Submit all materials to:
Scotland Elementary School
P.O. Box 97
68 Brook Road
Scotland, CT 06264
LAST NAME:
PERSONAL INFORMATION
FIRST NAME:
Preferred Prefix: (circle one)
None
Mr.
Mrs.
Street Address:
Ms.
Miss
Town or City:
Home Phone Number:
Cell
MIDDLE INITIAL:
Social Security Number:
Dr.
State:
Zip:
Work/Alternate Phone
Number:
E-mail address:
Best time of day to contact you?
Scotland Elementary School’s Non-Discrimination Statement:
Scotland Elementary School is committed to a policy of equal opportunity/affirmative action for all qualified persons and does not
discriminate in any employment practice, education program, or educational activity on the basis of race, color, national origin, sex,
age, disability, religion, sexual orientation, marital status, ancestry, genetic information, veteran status, gender identity or expression or any
other basis prohibited by Connecticut state and/or federal nondiscrimination laws. Each student is encouraged to develop and achieve
individual educational goals. SES will provide every student with equal educational opportunities. No student will be excluded on such
basis from participating in or having access to any course offerings, student athletics, counseling services, employment assistance,
extracurricular activities or other school resources. Inquiries regarding Scotland School’s nondiscrimination policies should be
directed to the Building Title IX coordinator, Jennifer Ridolfo, Scotland Elementary School, PO Box 97, Scotland, CT 06264, (860)
423-0064, the District Coordinator, Dr. Packman, or the Office for Civil Rights.
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EMPLOYMENT DESIRED
Position applying for:
Teacher
Paraprofessional
Nurse
Specials (Art, Music, Gym)
Cafeteria
Custodian
*If applying for substitute service, please indicate which days of the week you are available:
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Grades: (check all that apply)
PK
K
1
2
3
4
5
6
Are there any assignments/grade levels you are unwilling or uncomfortable working with?
Certificates and Diplomas
High School
Associates Degree
2 year Certificate
Paraprofessional Certificate
EDUCATION
Name of Institution
Year awarded
Bachelor’s Degree:
Master’s Degree:
Doctorate:
Other Degrees/Graduate Work:
REFERENCES
Please list three individuals, other than relatives, who can provide information concerning your work ability.
1.Name:
Address:
Telephone (between 9am-5pm)
Occupation:
2.Name:
Address:
Telephone (between 9am-5pm)
Occupation:
3.Name:
Address:
Telephone (between 9am-5pm)
Occupation:
EMPLOYMENT EXPERIENCE
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Current or most recently help position must be listed first. It is important to complete each section
below.
Current Employer:
From (month/year)
To (Month/Year
Name of Supervisor:
Annual Salary:
Address:
Or Hourly Rate:
Telephone #:
Reason(s) for leaving:
Former Employer:
From (month/year)
To (Month/Year
Name of Supervisor:
Annual Salary:
Or Hourly Rate:
Address:
Telephone #:
Reason(s) for leaving:
Former Employer:
From (month/year)
To (Month/Year
Name of Supervisor:
Annual Salary:
Or Hourly Rate:
Address:
Telephone #:
Reason(s) for leaving:
Former Employer:
From (month/year)
To (Month/Year
Name of Supervisor:
Annual Salary:
Or Hourly Rate:
Address:
Telephone #:
Reason(s) for leaving:
MILITARY SERVICE
Branch:
Rank:
Dates of Service:
If you need additional space regarding previous employment experience, please continue on another
sheet.
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ADDITONAL INFORMATION:
Summarize special job-related skills, qualifications, or training required
Personal Computer Use:
WINDOWS
MAC
Software Applications:
TABLETS
Special Skills:
Machinery/Equipment Operated:
Occupational Licenses or Certificates Held?(please attach copies)
VOLUNTARY INFORMATION
This information is requested on a voluntary basis, and will be used solely in connection with
Affirmative Action obligations and reporting requirements. Refusal to provide this information will
not subject the applicant to any adverse treatment. All information regarding a disability in
accordance with the ADA (Americans with Disabilities Act) will be kept confidential
Gender:
Ethnicity:
Race: (check all that apply)
White
Asian
Black or African American
Male
Hispanic
Pacific Islander
YES
Native Hawaiian or other Pacific Islander
Female
NO
Native American
Alaska Native
Person with Disability:
Type:
YES
NO
APPLICANT’S STATEMENT: PLEASE SIGN
I certify that answers given herein are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application for employment as may be necessary in
arriving at an employment decision. I understand that this application is not intended to be a
contract of employment. In the vent of employment, I understand that false or misleading
information given in my application or interview(s) may result in discharge or rescission of an offer of
employment. I understand, also, that I am required to abide by all rules and regulations of the Boards
of Education that may employ me.
Signature of Applicant:
Date:
This application will be kept in the Superintendent of School’s Office for 3 years from the initial date of
application.
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