Elmira City School District
“Preparing Students for the Future”

APPLICATION FOR EMPLOYMENT
NAME
Last: First: M.I.: Maiden:
ADDRESS
Street or P.O. Box: City: State: Zip:

Home Phone: Cell Phone: Email address:

POSITION APPLYING FOR: (check all that apply)

Bus Attendant Bus Driver Trainee Bus Driver Clerical Custodial
Food Service Nursing School Monitor Teacher Aide

Sub Bus Attendant Sub Bus Driver Sub Clerical Sub Custodial Sub Food Service
Sub Teacher Aide

CURRENT EMPLOYEE - Please check transfer or promotion and position/building. Sign the back and submit to Personnel.
TRANSFER PROMOTION Position/Building:

EDUCATION:

Type of School Name & Address of School From – To Degree Degree
(Mo. & Yr.) Program Awarded

High School or GED#
GED

College/Graduate School or
other Education

WORK EXPERIENCE: Complete all information required.

Length of Employment Employer Phone

From: To:
Job Title: Type of Business:

Name & Title of Supervisor: Reason for Leaving:

Job Duties:

Length of Employment Employer Phone

From: To:
Job Title: Type of Business:

Name & Title of Supervisor: Reason for Leaving:

Job Duties:

Administration Building 430 W. Washington Ave Elmira, NY 14901 PHONE (607) 735 – 3000 FAX (607) 735 – 3009

REFERENCES: (List the names of three (3) individuals familiar with your abilities.)

NAME ADDRESS PHONE NUMBER

1.

2.

3.

IT IS THE POLICY OF THE ELMIRA CITY SCHOOL DISTRICT TO PROVIDE FOR AND PROMOTE THE EQUAL
OPPORTUNITY OF EMPLOYMENT, COMPENSATION, AND OTHER TERMS AND CONDITIONS OF EMPLOYMENT
WITHOUT DISCRIMINATION BECAUSE OF AGE, RACE, CREED, COLOR, NATIONAL ORIGIN, SEX, DISABILITY,
MARITAL STATUS OR CRIMINAL RECORD.

DATE: _____________________ SIGNATURE: ______________________________________________________________

Mail to: Elmira City School District * 430 W. Washington Ave * Elmira, NY 14901 or Fax to: 607-735-3009

Administration Building 430 W. Washington Ave Elmira, NY 14901 PHONE (607) 735 – 3000 FAX (607) 735 – 3009