Non-Instructional Employment Application Survey

Please complete the following employment application. If any of the questions are not applicable to the position you are applying for, please enter N\A.

In addition to this application, resumes should be sent to resume@lutzprep.org.

All information provided by the applicant on this form is subject to verification and review by Hillsborough County Public Schools and Lutz Preparatory Schools, Inc. Official transcripts of all college course work reflecting degree attained and major will requested prior to a confirmed offer of employment.

This application and your resume will be kept on file for a period of twelve months from the date it is received.

1.Contact Information:(Required.)

First Name:

Last Name:

Middle Name:

Social Security Number:

Date of Birth

Street Address:

City:

State:

Zip:

Phone Number:

Email Address:

3.High School Educational Background:(Required.)

N/A:

Name of high school attended:

Address

Year graduated:

4.College or University Educational Background:(Required.)

N/A:

College\University attended:

Address:

Year graduated:

Major\Degree

5.Additional College or University Educational Background (if applicable):(Required.)

N/A:

College\University attended:

Address:

Year graduated:

Major\Degree

6.Other Educational Background (if applicable):(Required.)

N/A:

Other:

Address:

Year completed:

Course of study:

7.Employer #1 (please list the most recent experience first):(Required.)

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

8.Employer #2:(Required.)

N\A

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

9.Employer #3:(Required.)

N\A

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

10.Employer #4:(Required.)

N\A

Name of school or business:

Address of school or business:

Position title:

Dates of employment:

Supervisor's name:

Reason(s) for leaving:

Duties:

Starting salary:

Ending salary:

May we contact your employer? (Yes or No)

Phone Number:

Email Address (It is important that you include an email address for this person):

11.Professional Reference #1:(Required.)

Reference name:

Title\Position:

School or business:

Phone number:

Email Address (It is important that you include an email address for this person):

Time known:

12.Professional Reference #2:(Required.)

Reference name:

Title\Position:

School or business:

Phone number:

Email Address (It is important that you include an email address for this person):

Time known:

13.Professional Reference #3:(Required.)

Reference name:

Title\Position:

School or business:

Phone number:

Email Address (It is important that you include an email address for this person):

Time known:

15.List date you would be available to begin work at Lutz Preparatory.(Required.)

PLEASE NOTE: The application of any person with a criminal history requires review and approval to determine eligibility for employment. If you have such a criminal history, your application will be held i a pending file until the review process is complete.

16.CRIMINAL RECORD INFORMATION - ALL APPLICANTS PLEASE READ VERY CAREFULLY.

ATTENTION:

Under provisions in Florida Statutes 943.0585 and 943.059, the entire arrest record is revealed to school districts by the Florida Department of Law Enforcement and the FBI when fingerprints are supplied, including "sealed records" and "expunged records." Therefore, you are required to reveal such information on this application.

NOTICE TO APPLICANTS:
You must provide all information requested, regardless of whether your criminal record has been sealed in any part. Florida law allows the School Board access to sealed and/or all other criminal records. Information disclosed pursuant to this section will be evaluated on an individualized basis, taking into account the nature of the offense and underlying conduct, the relevance of the offense to the employment position(s) for which you are applying, the proximity in time of the occurrence of the offense in relation to this application, and other relevant factors. However, your failure to disclose any requested information will, in the absence of extraordinary, mitigating circumstances, result in the rejection of your application or, if the non-disclosure is discovered after your hire, the termination of your employment.

PLEASE NOTE: The application of any person with a criminal history requires review and approval to determine eligibility for employment. If you have such a criminal history, your application will be held in a pending file until the review process is complete.(Required.)

Yes

Have you ever been arrested or charged for a criminal offense other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)

Yes

Is there any criminal charge now pending against you other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)

Yes

Are you currently on probation or currently under any imposed requirements for charges other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)

Yes

17.CRIMINAL RECORD INFORMATION - ALL APPLICANTS PLEASE READ VERY CAREFULLY.

ATTENTION:

Under provisions in Florida Statutes 943.0585 and 943.059, the entire arrest record is revealed to school districts by the Florida Department of Law Enforcement and the FBI when fingerprints are supplied, including "sealed records" and "expunged records." Therefore, you are required to reveal such information on this application.

NOTICE TO APPLICANTS:
You must provide all information requested, regardless of whether your criminal record has been sealed in any part. Florida law allows the School Board access to sealed and/or all other criminal records. Information disclosed pursuant to this section will be evaluated on an individualized basis, taking into account the nature of the offense and underlying conduct, the relevance of the offense to the employment position(s) for which you are applying, the proximity in time of the occurrence of the offense in relation to this application, and other relevant factors. However, your failure to disclose any requested information will, in the absence of extraordinary, mitigating circumstances, result in the rejection of your application or, if the non-disclosure is discovered after your hire, the termination of your employment.

PLEASE NOTE: The application of any person with a criminal history requires review and approval to determine eligibility for employment. If you have such a criminal history, your application will be held in a pending file until the review process is complete.(Required.)

Yes

Have you ever been arrested or charged for a criminal offense other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)

Yes

Is there any criminal charge now pending against you other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)

Yes

Are you currently on probation or currently under any imposed requirements for charges other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)

Yes

18.Supplemental Information: Please provide any additional information which may support your application: i.e., Team Teaching, Awards, Endorsements, Curriculum Writing, etc. If you have already listed these on your resume you do not need to list them again.(Required.)

19.Authorization for Release of Information:

I certify that the answers given by me to the foregoing questions and statements are true and correct without any falsifications,omissions, or misleading statements of any kind whatsoever. I agree that Hillsborough County Public Schools and Lutz Preparatory Schools, Inc. shall not be held liable in any respect if I am not employed or if my employment is terminated because of false or misleading statements or answers or omission made by me in this application.

In addition, I understand that a condition of the application and/or employment process may require a drug test. Before you report to the school/site as an employee, you must be fingerprinted through the Professional Standards Department Fingerprinting Office of the Hillsborough County School District. The fingerprinting process includes a criminal background check.(Required.)

Applicant's signature:

I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information.

Today's date:

Non-Instructional Employment Application

Background Screening Information