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Optional Information
Birth Date
Format mm/dd/yyyy
Employee Number
Ethnicity
-- Select --
AMERICAN INDIAN (I)
ASIAN (A)
BLACK (B)
HISPANIC (H)
OTHER? (O)
PACIFIC ISLANDER (P)
WHITE (W)
Gender
-- Select --
Female (F)
Male (M)
Social Security No.
Format numeric only
Demographic Questions
Are you currently an EFPSB employee?
If you are a current employee, what s your Employee ID number?
What is your current position?
Other name(s) under which you have been employed?
Are you related to any of the current East Feliciana School Board Members?
Employer Questions
Full-time employees of the East Feliciana Parish School Board are required to join a state retirement system. Are you currently a member of a State Retirement System?
Yes
No
Are you retired from this state system?
Yes
No
If yes, What is the name of the school system?
If so, which system did you retire from?
-- Select --
Teacher's retirement of Louisiana
Louisiana school employees Retirement System
Louisiana State Retirement System
Louisiana Perochial
LSERS
None of the above
Are you under contract now?
Yes
No
If yes, ending date:
Are you on approved leave from a school system?
Yes
No
Have you ever been involuntarily terminated or asked to resign, or resigned in lieu of termination from any position?
Yes
No
If yes, please give the name of the employer, the date and the reason for the resignation or termination.
Have you ever been employed by the East Feliciana Parish School Board?
Yes
No
Security/Background Questions
Have you ever been convicted of a crime?
Yes
No
Month
Year
Explanation
Have you ever had a professional certificate revoked or suspended?
Yes
No
Month
Year
Explanation
Have you ever been involuntary terminated or ask to resign, or resigned in lieu of termination from another employer?
Yes
No
Month
Year
Explanation
Have you ever has a charge of child abuse against you substantiated?
Yes
No
Month
Year
Explanation
Have you been convicted of any offense for physical or sexual abuse of a child?
Yes
No
Month
Year
Explanation