<p> BEARDSLEY SCHOOL DISTRICT 1001 Roberts Lane Bakersfield, California 93308 (661) 393-8550 FAX (661) 393-5965</p><p>CLASSIFIED APPLICATION FOR EMPLOYMENT</p><p>Date </p><p>Position Last Name First Name MI Mailing Address [INCLUDE ZIP CODE] Home Phone Work Phone Cell Phone </p><p>Employment desired:  Full time  Part time, number of hours </p><p>Have you worked for a school system in California?  Yes  No Were you a member of the retirement system?  Yes  No</p><p>RECORD OF EDUCATIONAL PREPARATION</p><p>Name of high school attended </p><p>Highest grade completed: Graduated  GED Name of College/University </p><p>List languages, other than English, that you are familiar with: </p><p>RECORD OF WORK EXPERIENCE</p><p>List most current employment first.</p><p>Employer Date/From: To Current Employer  Please don’t contact  Address Phone Name of immediate supervisor Supervisor job title Your job title Reason for leaving </p><p>Employer Date/From: To Current Employer  Please don’t contact  Address Phone Name of immediate supervisor Supervisor job title Your job title Reason for leaving LEGAL INFORMATION</p><p>The following information is REQUIRED for your application to be considered. Your answers will not necessarily disqualify you from consideration, except for affirmative responses to certain enumerated sex and/or drug convictions and/or convictions for committing serious and/or violent felonies.</p><p>EXPLAIN ALL “YES” ANSWERS IN THE BOX BELOW THE QUESTION.</p><p>1. Have you ever been convicted of a felony or misdemeanor, or do you currently have a felony or misdemeanor charge pending? You are required to disclose all misdemeanor or felony criminal convictions including those based on a plea of no contest. You must disclose a conviction no matter how much time has passed, even if the case has been dismissed pursuant to Penal Code section 1203.4. In accordance with Health & Safety Code section 11361.5 and 11361.7, you may omit misdemeanor marijuana-related convictions that occurred more than two years prior to this application, except convictions involving concentrated cannabis, which must be disclosed regardless of the date of such a conviction.  Yes  No If “Yes”, list all convictions including, but not limited to convictions for “driving under the influence,” and convictions for sex and/or drug offense listed in Education Code Sections 44010 and 44011, except for convictions related to marijuana if it is more than two years after the date of the conviction. Include any serious or violent felony conviction in any state or jurisdiction as enumerated in California Penal Code Sections 667.6 (c) and 1192.7(c).</p><p>2. Have you ever been dismissed or asked to resign from any position?</p><p> Yes  No If you answered “Yes”, please explain below.</p><p>3. Beardsley School District does not discriminate on the basis of race, color, national origin, age, religion, political affiliation, gender, mental or physical disability, sex orientation, or any other basis protected by federal, state or local law, ordinance or regulation, in its educational programs or employment. No person shall be denied employment solely because of any impairment which is unrelated to the ability to engage in activities involved in the position(s) or programs for which application has been made. Will you need any reasonable accommodation to participate in the hiring process?  Yes  No If “Yes”, please explain below.</p><p>I certify that all statements made hereon are true and correct to the best of my knowledge. I understand that any false statements made on this application may be cause for non-employment or dismissal, if employed. I hereby authorize any investigation to obtain information required by this application.</p><p>Signature of Applicant Date </p><p>BEARDSLEY SCHOOL DISTRICT IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER</p><p>RETURN TO: Mr. Paul Miller, Superintendent, Beardsley School District, 1001 Roberts Lane, Bakersfield, CA 93308 PM:po/Revised 01/2015</p>