JACKSON PARISH SCHOOL BOARD Support Staff Employee Checklist:

JACKSON PARISH SCHOOL BOARD Support Staff Employee Checklist: Applicant s Name: Date Application Retuned: Check box of completed information and/or documentation: Education (if applicable to substitute employment position): Bachelor s Degree in Education - (attach copy of certificate) College Graduate (degree in other area attach a transcript and/or diploma) 1-3 years college - (attach transcript) High School graduate - (attach copy of diploma) Other (attach a copy) Background Check: Authorization To Disclose Criminal History Records Disclosure Bureau of Criminal Identification and Information Louisiana Identification (driver s license, Louisiana ID card, Military ID card) $55.75 processing fee (to be paid to the Lincoln Parish Sheriff Office cash or money order only!) Clear background Check Form(s) (attach copy) Other related forms and/or information: Employment Eligibility Verification (Form I-9) Copy of Driver s License Copy of Social Security Card Employment History completed References section completed All enclosed forms completed with prospective substitute employee signatures All related application questions answered and/or completed Business Department Forms to be completed: Form W-4 (Federal tax withholding form) Form L-4 (State tax withholding form) Packet processing may be delayed until all requested information and/or documentation has been received!

Support Staff Employment Packet Jackson Parish School Board In order to be considered for employment with the Jackson Parish School Board, the attached packet must be completed and returned with all documents requested to the office of the Personnel Director for processing. Packet Directions and General Information: Please do not return the packet until all of the information requested can be provided. 1. Application for Substitute, Contract or Part Time Hourly Support Staff Position: Complete all blanks on the application and return with the packet. 2. Substitute, Contract or Part Time Hourly Support Staff Fingerprinting Requirements: All Certified, Non-Certified personnel, Support Staff, Substitutes, Contract or Part Time Hourly support staff of the Jackson Parish School Board are required by law to be fingerprinted and to have a criminal background check conducted by the Louisiana State Police and a federal background check by the FBI. Return your completed packet to the Jackson Parish School Board Office front desk. The Authorization To Disclose Criminal History Records and the Disclosure Bureau of Criminal Identification and Information form contained within the application packet should be completed and signed. Applicants must also provide copies of their Louisiana Driver s License and Social Security Card. This information will be kept on file at the Jackson Parish School Board office for a minimum of one (1) year. Upon returning to the Central Office, the applicant will be sent to the Personnel Director, Mrs. Sharron Mosley or Ms. Sandra Burk for scheduling of fingerprinting at the Lincoln Parish Sheriff s Office. The criminal background checking process will be completed by the Lincoln Parish Sheriff s Office. Applicant will need to contact the Personnel Director, Mrs. Mosley or Ms. Burk after two or three days to see if background check was received and if there was anything that would disqualify them. Criminal Background results will not be accepted from previous employer nor will any Criminal Background documents be forwarded to other potential employers. No applicant will be considered for employment for a contract, permanent or temporary position or placed on the JPSB Substitute listing until a clear background check has been received. No applicant will be considered for employment for a permanent, contract, temporary position as a Paraprofessional within the district until they haves met the Highly Qualified requirements mandated by NCLB Law (example: passed ParaPro Test and the results have been received). Part-Day Substitute Teachers, Short-Term (certified/non-certified) Substitute Teachers, ISS Certified Personnel, some Support Staff and Support Staff Substitutes are not required to meet Title I Highly Qualified requirements. The school board considering the employment application of a person who has been evaluated in another school system shall request such person s evaluation results as part of the applications process and shall inform the applicant that his/her evaluation results will be requested. Listed references and resumes shall also be subject review and follow up contact concerning past employment and/or employment history. A $55.75 fee will be charged by the Lincoln Parish Sheriff s Office in order to have a Criminal background check done by the Louisiana State Police and the FBI. Only cash (exact amount) or money orders will be accepted for payment. Make money order payable to the Lincoln Parish Sheriff s Office. The fees for services provided by the Sheriff s Office are as follows: 1. Louisiana State Police fee ------------ $26.00 2. Local Sheriff s Administration fee - $10.00 3. Louisiana Sheriff s Association fee - $ 5.00 4. FBI Background Check fee ----------- $14.75 Total: $55.75

Contact Information: Lincoln Parish Sheriff s Office (Public Safety Complex) 170 Road Camp Road Ruston, LA 71270 Contact Number: (318) 251-5111 Hours of operation: 8:00 a.m. through 5:00 p.m. Days of Operation: Monday Friday (excluding national holidays) The Jackson Parish School Board is an Equal Opportunity Employer. Applicants are considered for employment on the basis of qualifications without regard to age, race/color, religion, national origin, sex, or disability or membership in any other protected classification. Inquiries concerning application of this policy may be referred to Ms. Bertha Robinson, Supervisor of Title IX and/or Ms. Dorothy Dorsey, Supervisor of 504 responsibilities. 3. Employment Eligibility Verification (Form I-9): Complete Section 1 - Employee Information and Verification. Sign and date where indicated. You must bring with you your current valid driver s license and Social Security Card. The Jackson Parish School Board requires that a copy of each of these be kept on file for each applicant. If you do not have these; please obtain them before returning your packet. 4. Form W- 4 (federal tax withholding form): Only complete the portion of the form below the dotted line. Sign, date, and return with your packet. 5. Form L- 4 (state tax withholding form): Complete only the portion below the dotted line. Sign, date, and return with packet. 6. Must have the following documentation submitted prior to being considered for hiring: Completed Application (with all blanks filled in and signature of applicant) on file Completed Fingerprinting process (fingerprint report returned with no hits) on file. Copies of Diplomas, Degrees and transcripts provided and on file. Copy of current Driver s License Copy of Social Security Card Highly Qualified form issued by the Title I Department (if required through Federal Law) Copies of ParaPro Test provide and on file for all prospective Paraprofessionals (full time, part time or contract)

JACKSON PARISH SCHOOL BOARD APPLICATION FOR Support Staff 315 Pershing Hwy Telephone: (318) 259-4456 Jonesboro, LA 71251 FAX: (318) 259-2527 Application For: Custodian Bus Driver Cafeteria Technician School Secretary Maid Bus Aide School Nurse (I, II or III) School Receptionist Central Office Secretary (12 Month) Central Office Payroll Coordinator (12 month) Paraprofessional - Have you taken the ParaPro Test? Yes No if yes, attach copy of scores. Other: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Name Last First Middle Maiden Address Street or Box Number City State ZIP Primary Phone #: - - #: Alt. Contact - - Social Security Number: - - Alt. Contact Name: Date of Birth: - - Today s Date: Diploma/Degree: High School or GED BA / BS MA / MS (Circle One) M+30 Ed. Spec. Ed.D / Ph.D. Email: EDUCATION Dates Attended School Name/Location From Until Major Minor High School Diploma/Degree Earned GED College or University Trade or Business EMPLOYMENT HISTORY (Beginning with most current) Name of Employer and Address Parish or County Telephone Position/Duties # of Years Dates

EMPLOYER REFERENCES Position Name of Organization Telephone Supervisor # of Years Dates NON-PROFESSIONAL AND/OR PROFESSIONAL REFERENCES Name Address Telephone Relationship GENERAL INFORMATION Are you related to an employee/board member of the school district(s) to which you are applying? Yes No If yes, list employee/board member s positon and relationship below: Employee s Position: Relationship: Employee s Position: Relationship: Are you presently under contract with any other school system? Yes No If Yes, expiration date: Have you ever been discharged, requested to resign or denied employment? Yes No If yes, please explain: Have you ever worked in Jackson Parish Schools? Yes No Dates: Are you retired from a Louisiana retirement system? Yes No If yes, which system? Have you ever been convicted of a crime or felony? Yes No Have you ever been accused, charged or convicted of sexual misconduct, abuse or neglect of a minor or student? Yes No Have you ever been convicted of, plead nolo contendere (no contest) to, or had a criminal offense expunged? Yes No DO NOT INCLUDE MINOR TRAFFIC VIOLATIONS. If YES, give the date, nature, and disposition of the offense. Yes No Are there any current charges pending against you? Yes No If applying as a Substitute Nurse - Do you have a current Louisiana Registered Nurse or LPN license? Yes No. If so, attach a copy to this application. Do you have military service that needs to be considered? NOTE: In some positons only highly qualified (according to NCLB Law) applicants will be considered for hire. State Department Of Education mandate for Nurse Certification is a minimum of two years (full-time) employment as a Registered nurse. * Although, an extensive work history is preferred.

Before you return this application, please attach the following items: 1. A copy of your most current Diploma or Degree from the High School, GED 5. A copy of your social security card provider, University or Trade/Business School from which you graduated 2. A copy of any test scores you may possess (example: NTE/Praxis/Para Pro Test 6. A transcript of all High School, GED or college work scores) 4. A copy of your driver s license 7. A Resume 5. Attach a copy of current State Nursing License and/or any other certificate you possess The Jackson Parish School Board is an Equal Opportunity Employer. Applicants are considered for employment on the basis of qualifications without regard to age, race/color, religion, national origin, sex, or disability or membership in any other protected classification. Inquiries concerning application of this policy may be referred to Ms. Bertha Robinson, Supervisor of Title IX and/or Ms. Dorothy Dorsey, Supervisor of 504 responsibilities. If employed by Jackson Parish School Board you will be required to submit to a State/Federal background check at a cost of $55.75 to be paid to the Lincoln Parish Office either in cash or money order. IMPORTANT: READ CAREFULLY I have read, understand and acknowledge the foregoing notice, conditions and directions for completing this application. I certify that the information provide herein and in the attachments hereto is accurate, true and complete to the best of my knowledge. I further certify that I have not been convicted of a felon and have not engaged in physical or sexual misconduct, neglect or abuse with or toward a student. I hereby wave my confidentiality with regard to my work record or criminal record consent to authorize the release of information from my current or former employers and/or law enforcement personnel upon inquiry in reference to this application. I release anyone responding to such inquiry from any liability for providing such information. Print Full Name DATE Applicant's Signature AUTHORIZATION AND RELEASE IMPORTANT: READ CAREFULLY Louisiana Revised Statutes 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 evaluation results as part of the applications process and shall inform the applicant that his/her evaluation results will be requested. The applicant shall be given the opportunity to review any information received by the prospective employer as a result of such request and afforded the opportunity to provide any response or information the applicant deems appropriate. Please be advised, therefore, that the Jackson Parish School Board will request evaluation results on you 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 requires all applicants for employment to be fingerprinted in order to assist in a background check of those individuals. Should it be determined that any applicant (or employee) have been convicted of or plead guilty to one 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. The conviction of other offenses that call into question the applicant s fitness for the position may also preclude employment or continued employment. 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 to provide it with all information relative to instances of sexual misconduct with students, if any, committed by the applicant. This law further provides that the applicant must release all such employers from liability arising from the release of such information to the prospective employer.

Louisiana Revised Statutes 44:1 et al. provides that public records are subject to production to persons requesting such information, including members of the press. Accordingly, I understand that the fact that I am seeking employment with the Board and my application may become public knowledge. AUTHORIZATION AND RELEASE IMPORTANT: READ CAREFULLY I certify that the information which I have provided in my application is true, correct and complete. I understand that furnishing false information or omitting material information on this application could disqualify me from consideration for employment or could lead to my discharge from employment. I have read and agree to the above provisions and hereby authorize the Jackson Parish School Board to request, receive, review and consider my prior evaluations and information relative to sexual misconduct, if any, with students for all of current or previous school system employer s or other employer s. In consideration of your accepting and considering my job application, I hereby release the Jackson Parish School Board, its employees, agents and insurers and all current and former employers, their agents, insurers and employees from any liability connected with such disclosures and do hereby specifically authorize such employer(s) to release to the Jackson Parish School Board such information and documentation as may be requested in connection with my application for employment with it. Print Full Name DATE Applicant's Signature NOTICE TO Substitute: The Louisiana School System does not knowingly discriminate against any employee or applicant for employment on the basis of race, color, religion, gender, age, national origin, handicap, or membership in any other protected classification, or status as a Vietnam era or disabled veteran. This policy encompasses recruitment, selection, assignment, promotion, transfer, termination, compensation, training and apprenticeship, and all other terms, conditions, benefits and privileges associated with employment. This policy extends to the educational programs and activities operated by the state, districts, and schools. Discrimination is specifically prohibited by Title IX of the Education Amendments of 1972, as amended, and Title 45, Subtitle A, Part 66, of the implementing regulations administered by the Director of the Office of Civil Rights of the United States Department of Health, Education, and Welfare.

JACKSON PARISH SCHOOL BOARD Wayne R. Alford, Superintendent P.O. Box 705 315 Pershing Highway Jonesboro, LA 71251-0705 Sexual Misconduct Disclosure Statement As required by R.S. 17:81.9 (Act 723), the applicant gives permission for all previous employers to disclose any information in the applicant s personnel file related to all instances of sexual misconduct with students committed by the applicant. The applicant releases previous and current employer s liability for providing the requested information to the Jackson Parish School Board. Please check box: I have read and understand the statement above. I understand that I cannot be considered for employment in the Jackson Parish School System unless this form is signed. I agree that a copy of this form will be sent to each of my previous employers and that each completed form received will be placed in my personnel file. Printed Full Name of Applicant Signature of Applicant Date Social Security Number *****This Section should be completed by the Previous Employer ***** Name of School System There is no information in this employee s personnel file indicating sexual misconduct. See attached documentation regarding sexual misconduct. Previous employer should complete this form and return it within twenty (20) business days to the following address: Samuel D. Strozier, Personnel Director Jackson Parish School Board PO Box 705 Jonesboro, LA 71251 Samuel D. Strozier, Personnel Director Date Signature of Authorized Human Resources Employee:

JACKSON PARISH SCHOOL BOARD P.O. Box 705, 315 Pershing Highway Jonesboro, LA 71251-0705 Telephone (318) 259-4456 Fax (318) 259-2527 REQUEST FOR PERSONNEL EVALUATION RESULTS In compliance with R.S. 17:391.5 h, Act 506, the Jackson Parish School System is requesting the evaluation results for: Name: Social Security Number: This request has been mandated as part of the application process of the Act. Sam Strozier Personnel Director Date *****This Section should be completed by the Previous Employer***** Year School System Job Assignment Evaluation Results Authorized Signature Date Previous employer should complete and return this form to: Sam Strozier/Personnel Dept. Jackson Parish School Board 315 Pershing Highway, P.O. Box 705 Jonesboro, LA 71251.

JACKSON PARISH SCHOOL BOARD P.O. Box 705, 315 Pershing Highway Jonesboro, LA 71251-0705 Telephone (318) 259-4456 Fax (318) 259-2527 Applicant Signature: Date:

SALES TAX NOTIFICATION IMPORTANT: READ CAREFULLY I certify that I understand that the local sales tax is not included in the State and/or Local Certified or Non- Certified Salary Schedules due to board policy and local taxation laws concerning sales tax supplements. I understand that only employees hired as full time or permanent may receive any distribution of sales tax. I also understand that the sales tax distribution amount is subject to change depending upon the stability of the local economy and the amount of sales tax collected within the parish. I further understand that the overall sales tax payment is only an estimate obtained from the previous year s amount received and that the amount I receive may change from one sales tax payment to the next. I have read, reviewed and understand all of the information in this notification prior to signing below. --------------------------------------------------------------------------------------------------------------------------------- Applicant Name: Print Applicant Signature: Date:, 20 Month Day Year ------------------------------------------------------------------------------------------------------------------------------- RETIRED PERSONNEL NOTIFICATION IMPORTANT: READ CAREFULLY Have you retired from a Louisiana certified position or a support staff position? ( ) Yes ( ) No IF yes, are you currently drawing retirement benefits through TRSL or LASER? ( ) Yes ( ) No If yes, name school system from which you retired: Retirement Date: Retired Support Staff/Teacher/Certified State Employee Statement As a retired Support Staff member, teacher or certified State Employee, I understand that I am responsible for maintaining and keeping up with my retirement benefits to ensure that I do not exceed any set TRSL or LASER retirement benefits guidelines. I also understand that the district has no obligation to check or ensure that I am following TRSL and/or LASER retirement guidelines concerning my retirement benefits due to returning to work in any capacity for the district. I have read, reviewed and understand all of the information in this notification prior to signing below. ------------------------------------------------------------------------------------------------------------------------------------------- Applicant Name: Print Applicant Signature: Date:, 20 Month Day Year

JPSB EMPLOYEES (PARAPROFESSIONALS AND SUBSTITUTE) DRESS CODE Jackson Parish employees, paraprofessionals and substitutes shall be expected to maintain a neat, clean and well-groomed appearance at school. It should be indicative of teaching as an honorable and respectable profession, and it should provide role models for the students along the lines of appropriate dress for social situations. Principals shall be responsible for compliance to the dress code within their schools. The dress code has been established to promote professionalism among the Jackson Parish employees, including aides, tutors and substitutes. However, it is recognized that certain teaching situations will require deviation from the dress code, and those circumstances will be determined by individual principals. Additionally, at each school there may be special days selected by the principals which will also allow deviation from the dress code. Personal Appearance School Food Service Permanent and/or Substitutes Uniforms of the same color, effective hair restraints, hose or socks, and low-heeled, enclosed shoes with non-skid/slip-resistant soles that provide adequate protection are standard for school food service employees and volunteer workers. Aprons should be worn over uniforms during food preparation and clean-up periods. Student workers must also wear effective hair restraints, jackets, smocks, or aprons. All employees and volunteer workers should be clean and neat at all times. Artificial nails are prohibited; Jewelry must be restricted to wedding bands and/or stud earrings. A laboratory coat may be worn over a uniform. A washable sweater may be worn when necessary. I have read, reviewed and understand all of the information in this notification prior to signing below. Applicant Name: Print Applicant Signature: Date:, 20 Month Day Year