ARGENTA-OREANA CUSD #1
APPLICATION FOR EMPLOYMENT
District Office üOne o Argenta-Oreana High School (217-795-4822)
500 N Main St., PO Box 440 o Argenta-Oreana Middle School (217-795-2163)
Argenta, IL 62501 o Argenta-Oreana Elementary School (217-468-2412)
Phone: 217-795-2313
Fax: 217-795-2174
Application Date Position(s) Applying For
Name
Address Home Phone
Cell Phone
Social Security #: Email
Certification Information
(Complete section for teaching and administrative positions)
IL Certification Number Certification Type Certification Expiration
Additional Teaching Endorsements
Educational Background
Place Attended Dates Diploma/Degree Special Areas of Study
Attended
High
School
College
College
Other
College Major: College Minor(s):
Areas of Highly Qualified Certification:
Student Teaching Experience
(Complete section if applicant for teaching position has less than five years teaching experience)
Name of School Address Phone
Supervising Teacher Grade Level Subject/Courses
Current Employment
(Complete section if applying for teaching or administrative position only)
Name of School Address Phone
Principal Grade Level Subjects/Courses
Extra-Curricular Assignments Year Started
o Check this box if this will be your first teaching position
Employment History
(All applicants should complete this section. Begin with your most recent position)
Position/Title Employer Address & Name Length of Employment Reason for Leaving
& Phone Number of
Immediate Supervisor
References
Name & Address Position Phone Number
1.
2.
3.
Please list any “Extra Curricular Activities” you would be interested in directing (where job appropriate):
BACKGROUND QUESTIONS
Have you ever been convicted of a criminal offense other than a minor traffic violation? Applicants are not
required to disclose sealed or expunged records of conviction or arrest. Yes No
Have you ever been discharged from any employment or did you ever resign under threat of discharge after
being accused of misconduct or poor job performance? Yes No
At any time during the last four years, did you receive any written reprimands or suspensions for alleged
misconduct or poor job performance? Yes No
Have you ever received an overall rating of unsatisfactory (or an equivalent) as the result of a job performance
appraisal or evaluation? Have you ever received a rating of unsatisfactory or “needs improvement” (or their
equivalent) for any specific categories of performance? Yes No
Are you prevented from being lawfully employed in this country because of Visa or Immigration Status?
Yes No
Is there anything that would prevent you from satisfactorily performing the duties of the position for which you
are making this application? Yes No
Have you ever been found in any action, by a court or disciplinary board, to have abused or exploited any
minor? Yes No
If you answer “Yes” to any of the previous questions, describe the circumstances on a separate sheet of paper,
and include with your application.
Please Note: You are not necessarily precluded from employment because of a criminal record. Consideration
will be given to the amount of time since the conviction, employment history since the conviction, the
relationship between the type of employment you are being considered for and the crime involved, and any
other circumstances or information that would pertain to your employment and the safe and efficient operation
of the school district. You will be precluded from employment and/or terminated if you give false or incomplete
answers on this application.
NOTICE TO APPLICANT
As an equal opportunity employer, Argenta-Oreana CUSD #1 complies with Federal and State laws prohibiting
discrimination in employment. Argenta-Oreana CUSD #1 makes all employment-related decisions without
regard to race, color, religion, sex, creed, national origin, ancestry, disability, marital or veteran status, sexual
orientation, pregnancy, or other unlawful considerations.
I understand that offers of employment are presented on a conditional basis and subject to School Board
approval. I understand that I must, if offered employment, submit to sexual offender and criminal background
investigations and that an offer of employment is subject to receipt of a criminal background check that does not
contain any prohibited offenses as outlined in the Illinois School Code and is otherwise satisfactory to the
School District. I further understand that an offer of employment is subject to receipt of positive
recommendations/references.
I understand that any offer of employment will be subject to compliance with the identification and employment
eligibility requirements imposed by the U.S. Immigration and Naturalization Service and/or the Department of
Homeland Security, and the successful completion of a health examination, including a tuberculin test.
I authorize the release to Argenta-Oreana CUSD #1 all high school, college, and other educational records
pertaining to my attendance, course work, and other school activities.
I consent to the disclosure of any and all information about me contained in private and government files
relevant to this application for employment or relating to my present and former employment history, and I
request all former employers, and federal, state, and local government agencies to supply said information to
Argenta-Oreana CUSD #1 on its request.
I authorize investigation of all statements contained in this application or made at any stage of this employment
process as may be necessary and appropriate in arriving at an employment decision.
I authorize and request my former employers to furnish Argenta-Oreana CUSD #1 with any personnel
information requested by it. I release you, my former employers, from any liability that may arise as a result of
your providing such information to Argenta-Oreana CUSD #1 and release Argenta-Oreana CUSD #1 and/or its
agents for any action taken due to information released by any school, government agency, or former employer.
I hereby certify that my statements are true and complete to the best of my knowledge. I understand that
the giving of false, misleading, or incomplete information, or the omission of relevant information on this
application or at any point in the application process is sufficient independent cause, to the extent
necessary, to cease further consideration of my application, or, if I am hired, for termination of
employment.
Applicant Signature Date
NOTE: Unsigned applications will not be processed and applicant will not be considered for
employment.
******************************************************************************************
OFFICE USE ONLY
Interview Date: Interviewed by:
Sex Offender Background Check Completed by: Date:
Reference Check Completed by: Date:
Action Taken: o Job Offer o Second Interview o Not Recommended oApplication on File
Assignment:
Additional Comments: