Bath Public Schools

39 Andrews Road

Bath, ME 04530

(207) 443-6601

APPLICATION FOR ADMINISTRATIVE POSITION

THE BATH SCHOOL DEPARTMENT DOES NOT DISCRIMINATE IN THE OPERATION OF ITS EDUCATIONAL AND EMPLOYMENT POLICIES AND WILL HONOR ALL APPROPRIATE LAWS RELATIVE TO DISCRIMINATION.

Date: _________________________________ Position(s) applying for:

Name: ________________________________ ______________________________________________

Social Security No: ________-______-_______ ______________________________________________

When will you be available? _______________ ______________________________________________

Permanent Address: _________________________________________ Phone: ______________________

Temporary Address: _________________________________________ Phone: ______________________

E-mail Address: _________________________________________________________________________

EDUCATION: Transcripts, including grades, from all college(s)/university(s) attended must be provided. It is essential that this section be completed accurately.

No. of Years Grade Point

College/University Attended Degree Awarded (if any) Attended__ Average__

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CERTIFICATION: List certification(s) you hold and provide copies of certification.

Type State Date Issued Date of Expiration

If you do not hold a Maine certificate, for what type of Maine certificate are you applying and eligible?

____________________________________________________________________________________________________________________________________________________________________________

State of Maine law requires that all public school employees be fingerprinted and a background check complete prior to being issued any type of Maine certification and beginning employment. You must have your fingerprints taken through a process approved by the Maine Department of Education. Information regarding fingerprinting sites in Maine is available at: http://www.informe.org/cgi-bin/doe/fingerprint.pl.

FINGERPRINTING/BACKGROUND CHECK: Complete: ______ Expiration Date: ________

Not Complete: ______ Date of Fingerprinting Registration: ____________________

NOTE: Candidates who do not hold Maine certification should direct an inquiry to the Maine Department of Education, Division of Certification and Placement, Augusta, Maine 04333.

EXPERIENCE: A resume must be provided. In addition to educational background and work experience, include extra-curricular activities in which you have been involved. Please list below positions held, employer and dates of employment for the past ten years. Please account for any gaps in employment on a separate page.

From (month/year) To (month/year) Position Employer

______________________________________________________________________________________

BACKGROUND:

Have you ever been disciplined, discharged, or asked to resign from a prior position? Yes___ No___

Have you ever resigned from a prior position after a complaint had been received

against you or your conduct was under investigation or review? Yes___ No___

Has your contract in a prior position ever been non-renewed? Yes___ No___

Have you ever not been nominated for re-employment in a prior position or ever had

your nomination for re-employment not be approved? Yes___ No___

Have you ever been charged with or investigated for sexual abuse or harassment

of another person? Yes___ No___

Have you ever been convicted of a crime (other than a minor traffic offense)? Yes___ No___

Have you ever entered a plea of guilty or “no contest” (nolo contendere) to any crime

(other than a minor traffic offense)? Yes___ No___

Have you ever had a professional license or certificate suspended or revoked in any

state, or have you ever voluntarily surrendered, temporarily or permanently, a

professional license or certificate in any state? Yes___ No___

Has any court ever deferred, filed or dismissed proceedings without a finding of guilty

and required that you pay a fine, penalty or court costs and/or imposed a requirement

as to your behavior or conduct for a period of time in connection with any crime (other

than a minor traffic offense)? Yes___ No___

If you have answered YES to any of the previous questions, provide full details on an additional sheet including, with respect to court actions, the date, offense in question, and the address of the court involved. Conviction or other disposition of a crime is not necessarily an automatic bar to employment.

REFERENCES: List three, two of whom are most recent supervisors, who can comment on your ability and whom we may contact. In addition, please provide three letters of reference from persons who are not related to you (may be from references listed below).

Name Position Address Phone

My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory possessed by any state, local or federal agency. I further authorize those persons, agencies or entities that the Bath Public Schools contacts in connection with my employment application to fully provide the Bath Public Schools any information on the matters set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the Bath Public Schools, its agents and officials or against any provider of such information.

I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include board members, administrators, other staff, and members of the community. I give my consent to this disclosure.

__________________________________

Signature/Date

APPLICATION FOR ADMINISTRATIVE POSITION CHECK LIST: The completed employment application cannot be evaluated unless of the following materials have been provided:

__________ Application form fully completed

__________ Copies of Transcript(s)

__________ Copy of Maine Certificate(s)

__________ Fingerprinting/Background check complete

__________ Resume

__________ Gaps in employment during the past ten years explained

__________ YES to any of the questions in the Background section explained

__________ Three letters of reference

__________ Application signed

NOTE: ALL APPLICATION MATERIALS BECOME THE PROPERTY OF THE BATH PUBLIC SCHOOLS. NONE WILL BE RETURNED. PROVIDING ANY FALSE OR MISLEADING INFORMATION ON THIS APPLICATION OR IN THE APPLICATION OR EMPLOYMENT SCREENING PROCESS SHALL BE FULLY SUFFICIENT GROUNDS TO REFUSE TO EMPLOY THE APPLICANT OR, IF THE APPLICANT HAS BEEN EMPLOYED, TO IMMEDIATELY DISMISS THE APPLICANT/EMPLOYEE.