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SAU 39 Amherst Mont Vernon and Souhegan Cooperative School Districts Internal Candidate Job Application Form Professional / Certified Staff If you need accommodations in completing this application please contact Human Resources. Name Date of Application Current Position Length of time in current position Current School / Administrator HQT Status NH Certification s Degree s I am applying for the following position Position Title School Please note or attach in the form of a cover letter and/or resume any pertinent information Employee s Signature The Amherst School District Mont Vernon School District Souhegan Cooperative School District and SAU 39 does not discriminate in its education programs activities or employment practices on the basis of race color religion pregnancy language sex national origin age disability sexual orientation genetics or veteran marital or citizenship status. This policy is in accordance with state and federal laws including Titles VI and VII of the Civil Rights Act of 1964 the Americans with Disabilities Act of 1990 the Age Discrimination in Employment Act the Equal Pay Act the Genetics Information Nondiscrimination Act Title IX of the Education Amendments of 1972 Sections 503 and 504 of the Rehabilitation Act of 1973 and RSA 354-A. Recommendation by Hiring Administrator Schedule Interview Not Selected / Not Qualified at this time Revised February 2012. Name Date of Application Current Position Length of time in current position Current School / Administrator HQT Status NH Certification s Degree s I am applying for the following position Position Title School Please note or attach in the form of a cover letter and/or resume any pertinent information Employee s Signature The Amherst School District Mont Vernon School District Souhegan Cooperative School District and SAU 39 does not discriminate in its education programs activities or employment practices on the basis of race color religion pregnancy language sex national origin age disability sexual orientation genetics or veteran marital or citizenship status. This policy is in accordance with state and federal laws including Titles VI and VII of the Civil Rights Act of 1964 the Americans with Disabilities Act of 1990 the Age Discrimination in Employment Act the Equal Pay Act the Genetics Information Nondiscrimination Act Title IX of the Education Amendments of 1972 Sections 503 and 504 of the Rehabilitation Act of 1973 and RSA 354-A. This policy is in accordance with state and federal laws including Titles VI and VII of the Civil Rights Act of 1964 the Americans with Disabilities Act of 1990 the Age Discrimination in Employment Act the Equal Pay Act the Genetics Information Nondiscrimination Act Title IX of the Education Amendments of 1972 Sections 503 and 504 of the Rehabilitation Act of 1973 and RSA 354-A. Recommendation by Hiring Administrator Schedule Interview Not Selected / Not Qualified at this time Revised February 2012. Name Date of Application Current Position Length of time in current position Current School / Administrator HQT Status NH Certification s Degree s I am applying for the following position Position Title School Please note or attach in the form of a cover letter and/or resume any pertinent information Employee s Signature The Amherst School District Mont Vernon School District Souhegan Cooperative School District and SAU 39 does not discriminate in its education programs activities or employment practices on the basis of race color religion pregnancy language sex national origin age disability sexual orientation genetics or veteran marital or citizenship status. This policy is in accordance with state and federal laws including Titles VI and VII of the Civil Rights Act of 1964 the Americans with Disabilities Act of 1990 the Age Discrimination in Employment Act the Equal Pay Act the Genetics Information Nondiscrimination Act Title IX of the Education Amendments of 1972 Sections 503 and 504 of the Rehabilitation Act of 1973 and RSA 354-A. Recommendation by Hiring Administrator Schedule Interview Not Selected / Not Qualified at this time Revised February 2012..

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