New District Employee Information
Demographics
I have been hired as:
Please select...
Full Time - Instructional
Full Time - Non-Instructional
Part Time - Instructional
Part Time - Non-Instructional
Last Name
First Name
Middle Initial
Prefix
Mr.
Mrs.
Ms.
Miss.
Dr.
Gender
Male
Female
Social Security Number
xxx-xx-xxxx
Date of Birth
Address 1
Address 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Contact Information
Home Phone
Is Phone Number Listed?
Yes
No
Mobile Phone
Personal Email
Ethniciy (needed for various State & Federal Reports
Please select...
American Indian or Alaska Native
Black or African American
Asian
Native Hawaiian/Other Pacific Islander
White (Not Hispanic)
Hispanic/Latino
Emergency Contact Information
Name of Person to be contacted in an emergency
Emergency Contact's Relationship to you
Phone Number of Emergency Contact
Marital Status
Marital Status
Please select...
Married
Single
Widowed
Divorced
Spouses Name
Spouses Date of Birth
Spouses Social Security Number
xxx-xx-xxxx
Dependent Information
Do you have Dependents?
Please select...
Yes
No
Dependent Child #1 Name (First & Last)
Dependent Child #1 Date of Birth
Dependent Child #1 Social Security Number
Do you have a Second Dependent?
Please select...
Yes
No
Dependent Child #2 Name (First & Last)
Dependent Child #2 Date of Birth
Dependent Child #2 Social Security Number
Do you have a Third Dependent?
Please select...
Yes
No
Dependent Child #3 Name (First & Last)
Dependent Child #3 Date of Birth
Dependent Child #3 Social Security Number
Do you have a Fourth Dependent?
Please select...
Yes
No
Dependent Child #4 Name (First & Last)
Dependent Child #4 Date of Birth
Dependent Child #4 Social Security Number
Do you have a Fifth Dependent?
Please select...
Yes
No
Dependent Child #5 Name (First & Last)
Dependent Child #5 Date of Birth
Dependent Child #5 Social Security Number
Board of Education Policy Acknowledgements
I acknowledge that I have reviewed the Sexual Harrassment Policy as set forth by the Beekmantown Board of Education
0110 Sexual Harassment
I acknowledge that I have reviewed the Anti-Bullying Policy as set forth by the Beekmantown Board of Education
0115 Anti-Bullying
I acknowledge that I have reviewed the Smoking on School Premises by Staff Policy as set forth by the Beekmantown Board of Education
1530 Smoking on School Premises by Staff
I acknowledge that I have reviewed the School District Office and Employee Code of Ethics as set forth by the Beekmantown Board of Education
2160 School District Office and Employee Code of Ethics
I acknowledge that I have reviewed the Confidentiality Agreement for Substitutes and Employees Policy as set forth by the Beekmantown Board of Education.
5500 E.5 Confidentiality Agreement for Substitutes and Employees
I acknowledge that I have reviewed the Drug-Free Workplace Policy as set forth by the Beekmantown Board of Education.
9320 Drug-Free Workplace
I have reviewed and understand the above referenced Beekmantown Board of Education Policies. In lieu of your signature, please type your Full Name below.
reCAPTCHA helps prevent automated form spam.
The submit button will be disabled until you complete the CAPTCHA.
Contact Information