NORTH LAWRENCE COMMUNITY SCHOOLS
460 W Street, P.O. Box 729
Bedford, IN 47421
             
This Section for Official Use Only
             
Date Received:_____________ By ______________________ Test Score ________________ Date ________
             
Official Action: Hire as ___________________________ At ______________________________________
             
  Hourly Rate ________________ Hours per Week _____________ Status_____________________
             
  Beginning Date _____________________ Initial of Employing Official __________________

SCHOOL NURSE- APPLICATION FOR EMPLOYMENT
 
Name:
Date: 10/23/2018
  First Middle Maiden Last  
 
Address:
Telephone:
  Street/R.R. City Zip Code  
 
 
Date available to begin work:
 
Do you have any physical or mental impairments that would interfere with your ability to perform the job for which you have applied?
 
School(s) in which you have children enrolled:
 
EDUCATION
Select highest grade level complete: High School 9 10 11 12 -- College 1 2 3 4 5 6
 
List any certifications that you hold:
 
Have you had experience with any of the following?
Assessing, identifying, and monitoring health needs of students.
Service as a Health educator and resource person.
Service in providing health counseling to individual/families.
Visual Acuity Screening
Audiometric Screening
Dental Screening
Height and Weight Screening
 
Tell us about your experience with children:
 
Why would you like to be a School Nurse?
 
  Date of Employment Employer Your Position Reason for Leaving
1.
2.
3.
4.
 
 
REFERENCES:
Name Address Phone Profession
       
Name Address Phone Profession
       
Name Address Phone Profession
 
I hereby certify that to the best of my knowledge the foregoing statements are true and complete. I further understand that this application will become a part of my permanent personnel file should I become employed by the North Lawrence Community Schools. I also give permission for this perspective employer to receive and view any copies of my school, college and/or work records.
 
______________________________________________________________
Date: _________________
Signature
 

If you are hired for a position with North Lawrence Community Schools, administrative personnel must process a criminal history check. The applicant will be required to cover the cost for the criminal history check. If you are hired for a position with North Lawrence Community Schools, administrative personnel must process a criminal history check/child abuse registry check. You will receive an invitation by email from the personnel department to process this information through Safe hiring solutions and payment will need to be made by credit/debit card.

An authorization form must be completed before the Criminal History check is done.

Note: This application will be kept active for two (2) years unless employed during that time.