Mill Hollow Application2.pdf - Granite School District

Date of Application:
501 E. 3900 South
Salt Lake City, UT 84107
385-646-4668
fax:385-646-4667
www,granitepeaks.org
Mill Hollow
Employment Application
AN EQUAL OPPORTUNITY EMPLOYER
Granite School District is an equal opportunity employer and does not
discriminate on the basis of race, color, religion, national origin, sex or physical
or mental disability, except where justified to meet a bona fide occupational
requirement. If you are a qualified individual with a disability who needs
assistance with the application process, please contact the District Human
Resource office at 385-646-4511. Granite School District is committed to keeping
our work force drug free and free from harassment of any type.
APPLICANT INFORMATION
Legal Name:
Last
First
Middle
Present Address:
Home Address:
Home Phone:
Street
Street
Cellular Phone:
Apartment
Apartment
City
City
State
State
E-Mail Address:
Zip Code
Zip Code
Are you at least 18 years of age? Yes No If younger than 18, give Date of Birth:
POSITION INFORMATION
POSITION YOU ARE APPLYING FOR:
Cook ($10.50/hr.)
Number preference - 1 being most desired and 6 least desired.
Cabin Counselor ($10.00/hr.)
Cook Helper ($10.00/hr.)
Custodian ($10.50/hr.)
Host/Hostess ($10.50/hr.)
How soon could you be available for work if you are offered the position?
What is the latest date you would be available to work?
Are you related to any current District employees?
Board Policy restricts the employment of relatives under specific circumstances.
Have you previously been employed by the District?
No Yes If yes, who/relationship:
No Yes If yes, provide date(s) of employment and position(s) held:
EDUCATION Year/s
Year Degree
High School Attended
Attended Graduated Earned
Diploma
GED
Post High School Institutions Attended
Course of Study
List any special skills, training, qualifications, certificates or licenses relative to the position for which you are applying:
Have you ever been to Mill Hollow?
Yes
No
If yes, when?
Were you... Staff Student Other
Do you know or are you acquainted with any previous Mill Hollow staff?
Yes
No
If yes, who?
Are you a US citizen or do you have a current right to work visa?
Yes
No
Application con't. on reverse

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EMPLOYMENT HISTORY HISTORY& & WORK WORK REFERENCES REFERENCES
Provide names and addresses of employers you have worked for during the last ten (10) years. Please include a contact person who
supervised your work while employed. Start with your most recent employer.
Dates of
Name of Firm
Position Held
Employment Address Contact Person
Phone
Number
PERSONAL REFERENCES
Provide names and addresses of three (3) personal references (no family members) who have knowledge about your character.
Name Phone Number Length of Time Known Nature of Acquaintance (Supervisor, Coworker, Religious Leader, Civic Leader, etc.)
The following questions are to assist in determining a prospective employee's fitness as an applicant to the District. The answers to these
questions are subject to verification by a police agency. A "yes" answer does not automatically disqualify an applicant. Each application
will be reviewed individually.
Have you ever been charged with violations of law involving minors, sex, lewdness, abuse, fraud, embezzlement? Yes No
Have you ever been convicted of: a. A sex-related crime that involved force or minors? Yes No
b. A crime involving violence or the threat of violence? Yes No
c. A crime or criminal activity involving drugs or alcoholic beverages? Yes No
d. Any other conviction other than a minor traffic violation? Yes No
If you answered yes to any of these questions, please indicate the charge and the disposition of the charge below:
Date of conviction:
e. Have you ever been convicted, pled guilty or 'no contest' or been
sentenced for any other offense? Yes No
if you answered yes to this question, please indicate the charge and the disposition of the charge:
Date of conviction:
Please note that if you are presently charged or under indictment for a criminal offense, upon a finding or plea of guilty (or no contest) you
shall provide that information to the Granite School District.
Have you ever been asked to resign or been terminated or non-renewed from any employment or volunteer position? Yes No
If yes, please explain:
SIGNATURE AGREEMENT AND RELEASE
I certify that all of the above information provided in the application is true and complete. I further agree that if I have provided false,
misleading or incomplete information, the District may disqualify me as an applicant or terminate my employment immediately. I
understand that this application and records become the property of the District. I authorize Granite School District to inquire with former
employers and/or references and to obtain any and all information regarding my job related background and qualifications. I release and
waive Granite School District, my former employers and all references from any and all liability in obtaining such information. I also
recognize that in accordance with Utah State Law, the District may conduct a criminal background check and I hereby waive my right to
further written notice of such. I understand that if employed, the employment is temporary pending completion of all required documents
and the outcome of history and background check investigations. If I am presently charged or under indictment for a criminal offense, upon
a finding or plea of guilty I shall provide that information to Granite School District. I further understand that all substitutes are classified as
temporary and are therefore employed "at will'' by the District. I further agree to observe all rules, regulations and policies of the District.
Applicant Signature
Date
Rev. 1-12