* Have you been a domiciled resident of the City of Buffalo for at least the last 90 days?

If no, are you able and willing to establish domiciled residency within the City of Buffalo within 90 days?

* Have you ever submitted an application with BPS?

* Have you ever been employed by BPS (if  not a current employee)?

If you are a former employee, when were you last employed by BPS and what position did you hold? (Month/Year)

* How did you hear about this employment opportunity?

If other, please explain:

* Have you ever been dismissed or asked to resign from employment; or had an employment contract non-renewed in lieu of termination?

If yes, please explain:

* Can you travel if a job requires it?

* Are you legally authorized to work in the United States?

* Will you now, or in the future require Buffalo Board of Education to commence (sponsor) an immigration case in order to employ you (for example, H-1B or other employment-based immigration case)?

* Have you been fingerprinted pursuant to Part 87 of the Regulations of Commissioner of Education?

* Do you speak another language fluently?

* If so, what language(s)?

* Are you 18 years of age or older?

* Have you earned a High School Diploma or GED?

* Name of School/Program:

* Date of graduation:

* Have you worked with children aged Pre-K to 12th grade, in any capacity ? (this would include internships, volunteer experiences, and other non-paid work experiences)

If so, please give the name of the organization or person (s) where you have worked with children Pre-K to 12th grade, dates of service, and detailed description of responsibilities/duties?

* What is your work preference?

* What days are you able to work?

* If needed, are you able to work on the weekend?

* Are you currently employed?

Name of most current employer?

Job Title?

Street Address

City

State

Zip

Start date?

End date? (leave blank, if still employed)

Supervisor's Name?

Provide a brief description of the duties you perform(ed):

Specific reason for leaving (or seeking other employment)?

May we contact this current employer?

Name of employer prior to the most current?

Job Title?

Street Address

City

State

Zip Code

Start Date

End date? (leave blank, if still employed)

Supervisor's Name?

Provide a brief description of the duties you perform(ed):

Specific reason for leaving (or seeking other employment)?

May we contact this employer?

Name of employer prior to the previously listed employer?

Job Title?

Street Address

City

State

Zip

Start date?

End date?

Supervisor's Name?

Provide a brief description of the duties you performed?

Specific reason for leaving (or seeking other employment)?

May we contact this employer?

* First Reference Name:

* Contact Information: (i.e. address and phone number)

* Second Reference Name:

* Contact Information: (i.e. adddress and phone number)

* Third Reference Name:

* Contact Information: (i.e. address and phone number)

* Have you ever been convicted of a felony or misdeamnor crime?

* Are you the subject of pending criminal charges or investigation?

* Have you ever had your teaching certificate suspended or revoked?

* Were you ever dismissed from a school district conferring tenure pursuant to Education Law section 3020a?

* I certify that the answers given herein are true and complete without omissions of any kind. I understand that any misleading or incorrect statements will render this application void, and if employed will result in termination. I agree that The Buffalo Public School District shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this application.

I also authorize pertinent; companies, schools, agencies or persons to give any information requested regarding my employment, character, experience, qualifications and/or suitability for employment. I hereby forever release, discharge and covenant not to sue any person or organization for any result of providing, obtaining or acting upon such information. I understand that such information is sought with confidentiality and I will not request copies of such information. In addition, a copy of this authorization is as valid as the original and should be recognized as such.

I understand that any offer of employment or continued employment, if hired, may be conditioned upon a background check and physical examination, including substance abuse screening. Refusal to participate will result in termination or denial of employment.