Todd Wilson

Experienced professionals salesperson

• Simi Valley Unified
• 101 W. Cochran St.
• Simi Valley, CA 93065
• Www.simivalleyusd.org
• FIRST NAME________________________ LAST NAME________________________ LAST 4 # SSN____________
• POSITION APPLIED FOR:
• ______________________________ ______________________________ ______________________________
• SCHOOL SITE/LOCATION POSITION TERM/SEASON
• RESPONSES INITIAL HERE QUESTIONS
• Yes No ___________ Have you ever been terminated (fired) from any position (job)?
• Yes No ___________ Have you ever been asked to resign from any position?
• Yes No ___________ Have you ever been the subject of a job related investigation or complaint?
• Yes No ___________ Have you ever been demoted by any employer?
• Yes No ___________ Have you ever been disciplined by any employer?
• Yes No ___________ Have you ever been convicted or plead guilty to any criminal offence (crime)?
• Yes No ___________ Have you ever been reported, to any state, country, or municipal agency for causing injuries or abuse to a person under the age of 18 years?
• Yes No ___________ Do you have any reason to believe that any of your past or present employers will give you an unfavorable recommendation?
• Yes No ___________ Have you ever been the subject of any credible complaints of, substantiated investigations into, or discipline for, egregious misconduct?
• Yes No ___________ Have you ever been reported to the California Commission on Teacher Credentialing?
• REVIEW AND SIGN:
• I HEREBY CERTIFY that my answers to the questions above are true and complete to the best of my knowledge.
• ______________________________ ______________________________ ______________________________ ______________________________
• APPLICANT SIGNATURE PRINT NAME DATE