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 Birth Date  Format mm/dd/yyyy
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 Social Security No.  Format numeric only
 
Demographic Questions
 
United States Citizen?
 
 

If not (United States citizen), do you have legal right to work in this country?
 

 
Employer Questions

STOP

 

BEFORE YOU FILL OUT THIS APPLICATION

BE SURE TO READ AND UNDERSTAND THIS...

 

  • We ask certain questions concerning your health and your criminal history.
  • We verify the answers you provide through appropriate agencies.
  • As an educational agency, we are entitled to a complete criminal history report on you.
  • This report includes anything for which you have been arrested and/or convicted.
  • This report also includes information on arrests, convictions, or plea bargains for which you may have subsequently received pre-trial interventions, pardons, or expungements.

That does NOT excuse you from listing these on your application even if the charges were dropped.

  • There is no time limit or other reason to fail to report an arrest or conviction.

YOUR SIGNATURE BELOW INDICATES THE FOLLOWING:

  • You have read and understand the above.
  • You understand that your employment is contingent upon a satisfactory record check that is in accordance with the answers you provided.
  • Record checks sometimes take significant time to be returned.
  • You understand that our offer of employment is based on an evaluation of the information you have provided. If that information is inaccurate, false, or misleading, that will be grounds to terminate your employment upon receipt of the report.

 

RAPIDES PARISH SCHOOL SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER. APPLICANTS ARE CONSIDERED FOR EMPLOYMENT ON THE BASIS OF QUALIFICATIONS WITHOUT REGARD TO RACE, COLOR, NATIONAL ORIGIN, RELIGION, AGE, SEX OR HANDICAPPING CONDITION.

 

AS PROVIDED BY FEDERAL LAW, APPLICANTS MAY REQUEST ACCOMMODATIONS IN ORDER TO COMPLETE THE APPLICATION OR TO TAKE ANY REQUIRED EMPLOYMENT TEST.

 

 

AUTHORIZATION AND RELEASE

 

IMPORTANT: READ CAREFULLY

 

Louisiana Revised Statues 17:3884 provides that a school board considering the employment application of a person who has been evaluated in another school system shall request such person's evaulation results as part of the application process and shall inform the applicant that his/her evaluation results will be requested. The applicant shall be given the opportunity to review any informatiion received by the prospective employer as a result of such request and to provide any response or information the applicant deems appropriate. Please be advised, therefore, that the Rapides Parish School Board will request your evaluation results from each of the school districts you have listed in your application. You will be given an opportunity to review the evaluation results received and to provide a response or information if you would like to do so. Any written response or information you might provide will be retained with your application.

Louisiana Revised Statutes 17:15 also requires all applicants for employment to be fingerprinted in order to assist in background checks of those individuals. Should it be determined that any applicant (or employee) has been convicted of one or more of the criminal offenses set forth in Louisiana Revised Statutes 17:587.1(C), then that applicant (or employee) is generally precluded from further employment with the school system. Failing to disclose an arrest or conviction or providing any other incomplete or inaccurate information on your application shall also be grounds for termination.

Louisiana Revised Statutes 17:81.9 further requires a school board receiving an application to request that all current and prior school board employers of the applicant provide it with all information in their records relative to instances of sexual misconduct with students committed by the applicant, if any.

Louisiana Revised Statutes 17:81.9 and 17:430 further require all applicants to make certain disclosures relative to prior abuse and neglect allegations, if any. The applicant must also release all such employers from liability arising from the release of such information to the prospective employer.

 
I have read and understand all the conditions listed above. Please initial and date.  
 

Are there any reasons which would prevent or restrict you from discharging your duties or responsibilities according to the Rapides Parish School Board job description?  
 

I understand that it is my responsibility to obtain forms for verification of the previous employment from the Human Resources Department and send them to past employers.

I understand that I may not be given salary credit for past employment until the forms are received and approved by the Human Resources Department.

Please initial here:
 
 

BACKGROUND:

1. Have you ever been arrested for any crime, whether a felony or misdemeanor?
 
 

2. Have you ever been convicted of an offense against the law or are you now under charges for an offense against the law?
 
 

3. Have you ever been terminated or recommended for dismissal by your employer?
 
 

4. Have you ever had a professional license or certificate revoked?
 
 

5. Are you related to an employee / board member of Rapides Parish School Board?
 
 

6. Are you retired from the LA Teacher's Retirement or School Employees' Retirement System?
 
 

7. Did you participate in DROP (Deferred Retirement Option Program)?
 
 

8. Are you currently receiving Worker's Compensation?
 
 

9. Have you worked for the Rapides Parish School Board before?
 
 

      If you checked YES for any of the questions above, please explain in the space given here:
 

RELEASE OF INFORMATION

I authorize Rapides Parish School Board to investigate my background, references, character, past employment, education, credit history, criminal or police records for the purpose of confirming the information in this application and/or obtaining information pertinent to my qualifications for employment.

My keyed in affirmative reply shall serve as authorization to release the requested information.
 
 

I authorize Rapides Parish school Board to request information from my current or previous employer (if a city, parish, or other local public school board), relative to all instances of sexual misconduct with students committed by me.
 
 

I hereby release Rapides Parish School Board, employers, schools, or persons from liability in responding to inquires in connection with my application.
 
 

I understand that I must abide by the terms of the Rapides Parish Drug-Free Workplace Policy. As part of the application process, I understand that I must submit to a pre-employment drug screen.
 
 

If employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
 
 

I CERTIFY THAT ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEGE. I HAVE READ AND AGREE WITH THE INFORMATION PROVIDED ME.

THE APPLICANT ACKNOWLEDGES THAT ANY OFFER OF EMPLOYMENT MUST BE APPROVED BY THE SUPERINTENDENT.

Please give full name and date here:
 
 

ABUSE AND NEGLECT INQUIRY

     Pursuant to the foregoing statutes, you must answer each of the following questions truthfully and completely. If your answer to any question is "Yes", you must complete the explanation questions thereunder.

     Any applicant who knowingly and willfully provides incomplete or false answers to any of the following questions shall be guilty of a misdemeanor and shall be fined not more than five hundred dollars or imprisoned for not more than six months, or both.
 
 

1. Have you ever engaged in sexual misconduct with a minor or student?
 
 

2. Have you ever been accused of sexual misconduct with a minor or student?
 
 

3. Within thirty-six months before or after your resignation, retirement or termination from your previous employment, have you been the subject of any investigation of alleged sexual misconduct with a minor or student?
 
 

4. Have you ever abused or neglected a minor or student?
 
 

5. Have you ever been accused of abusing or neglecting a minor or student?
 
 

6. Have you ever been the subject of an investigation of alleged neglect or abuse of a minor or student?
 
 

  
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