LEE PUBLIC SCHOOLS APPLICATION FOR EMPLOYMENT

Date of Application: __________________ Position Applied For: ______________________________

Name:

______________________________________________________________________________ (Last)

(First)

(Middle Initial)

Address: ________________________________________________ (Street)

________________________________________________ (City)

Home Phone:

(State)

(Zip Code)

_______________________________________ Cell Phone: ______________________

E-mail Address: _______________________________________ EMPLOYMENT EXPERIENCE Please list experience beginning with your most recent employment:

Dates From-To

No of Years

Position/Responsibilities

Employer

Location

Education Institution

Dates Attended

Major

Degree

Date Granted

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REFERENCES Please list three persons who are familiar with your professional competence. Forward letters of reference to the Superintendent of Lee Public Schools, unless they are included in other application materials. Name Position Address Telephone 1. ____________________________________________________________________________________ 2. ____________________________________________________________________________________ 3. ____________________________________________________________________________________ May we contact your current employer?

 Yes

 No

If Applying for Full Time Teaching Position, please provide the following: 1. Copy of an Official Transcript indicating degrees awarded (to be requested by the applicant). 2. Copy of Teaching Certificate. Mail or deliver the application and related materials to: Office of the Superintendent Lee Public Schools 300A Greylock Street Lee, MA 01238 APPLICANT’S STATEMENT 

I understand that at some point in the selection process, the information contained in this application may be made available to the public. Also, I understand that the facts set forth herein will be subject to verification. Any misleading information may lead to discharge.



I understand that the hiring of any applicant is subject to a National Background and CORI Records check, satisfactory to the employer, and is a condition of hiring or continuation of employment prior to the receipt of the above referenced criminal checks.



I understand the fee for National Background Check is currently $55 for school employees licensed under Section 38G (DESE-licensed individuals employed as educators and specialists, and any other employee who holds DESE licensure, regardless of her/his position) and $35 for all others.



PLEASE NOTE: Substitutes are school employees under the new law and therefore must submit their fingerprints for state and national checks. If substitute teachers hold educator licenses under MGLc.71 s.38R, they will pay the $55 fee; otherwise they will pay the $35 fee.

__________________________________________________________

______________________________

Signed

Date

The Lee Public Schools is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, sex, gender, gender identity, disability, religion or sexual orientation. TO BE COMPLETED BY DISTRICT OFFICE (circle Y or N) CORI Records Check Completed

Y

N

National Background Check (fingerprinting)

Y N

Payroll Forms Completed

Y N

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