MILTON-UNION EXEMPTED VILLAGE SCHOOLS

7610 Milton-Potsdam Rd
West Milton, OH 45383
(937) 884-7910

APPLICATION FOR CLASSIVIED PERSONNEL

„,. , -- 77 n . 1
Position(s) Applied For W.YS 'ORI V R.‘ I CUSM))il"'!„--) I t.... ,t ,, Date of Application /0/„;23 1/ (.-2
Name 1\tOR114-* __.\ E,
- ,t. `i L ,
(Last) (First) (Middle)
Address
(Street) (City) (State) (Zip)

E-mail

Telephone Social Security Number

Have you ever been employed here before Yes1 No Are you legally eligible for employment in this country? X Yes No
(Proof of U.S. Citizenship or immigration status will be required upon employment)
Date available for work N0V . a b I (c, Type of employment desired )< Full Time Substitute Seasonal
I understand certain criminal convictions will disqualify me from employment in some or all positions.
Driver's license number (if job related) State OHIO
Have you ever had your driver's license revoked or suspended? 4,', Yes No
atioCCRS, PC.c.Er a iletSt:WE 42 ' s° riV -
Employment History
List your last three (31 employers, starting with the most recent, including military experience.
From: To: Employer Telephone
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Job Title Address
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Immediate Supervisor , Nature of work performed & job responsibilities
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Reason for leaving Hourly Rate/Salary
Start $ 53 . ilO per Final $ S • IC) Per

From: To: Employer Telephone

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Job Title Address
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Immediate Supervisor Nature of work performed & job responsibilities
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Reason for leaving Hourly Rate/Salary
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From: To: Employer . Telephone
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Job Title Address
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Immediate Supervisor Nature of work performed & job responsibilities
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Reason for leaving Hourly Rate/Salary
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1 14- Final $ j per
 Skills and Qualifications
Please note special skills, qualifications, knowledge and/or training that may qualify you for this position.

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Educational Background

Name and Location Years Completed Did you Graduate? Course of Study

High School
-11:0• taise4oca As Sg...=, 7:dleho'P ii 8 i '4es ALL.,_
College sixar. Major Degree
GI: D oSIL-10,1
.S1 6,1O-44 I0, A/CA- Aio
Other k.,32. tGA-T-
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References

Name Address Telephone Years Known

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ivi AitY- .av6-INO 1kaiwiaail_ -0'ut)634) -2.a..)-%itic 30\lips .
CA4-1.- VAkec 6: 1-itis' . .i4aStia l- On
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1 gb k4 05
1... . -Si i-liige'L,
Greve C.4-ciiVeriez imot,A.,,icorpa-- iNk-rruiLlpou (43-i) g-HL.--m6) 31 ilS

I certify that the answers given in this application, as well as the information contained in any resume and transcript I submit, are true and complete
to the best of my knowledge.

I authorize investigation of all statements contained in my application, resume, and transcript as may be necessary in arriving at an employment
decision.

In the event of employment, I understand that false and misleading information given in my application, resume, transcript, or interview(s) may
result in discharge.

I also understand that I am required to provide a set of impressions of my fingerprints, at expense of applicant, and that a criminal records check is
required to be conducted and satisfactorily completed, in accordance with Section 109.572 of the Ohio Revised Code, as a precondition to my
employment.

In accordance with Federal law, any person employed by this District must provide evidence that s/he is eligible to work in the
United States.

I have read the job requirements, as posted, and I certify that I am able to perform all requirements, including physical or agility
requirements, if any, without restrictions.
Signature ofApplicant fIc Date

NOTE: This appliCation will be kept on filefor one school year beyond application date.

STATEMENT OF NONDISCRIMINATION
It is the policy of this District that no candidate for a position in this District shall be
discriminated against on the basis of race, color, religion, national origin or citizenship
status, creed or ancestry, age, gender, marital status, non-disqualifying disability, height, or
other protected categories
 MILTON-UNION EXEMPTED VILLAGE SCHOOLS
Board of Education Office

'hone: 937-884-7910 7610 Milton-Potsdam Road, West Milton, Ohio 45383 Fax: 937-884-7911

Brad Ritchey, Ph.D. Kay Altenburger

Superintendent Treasurer

January 11, 2017

Mr. Jerry North

Dear Mr. North:

Thank you for your application for Substitute Bus Driver, Custodian and Cafeteria Worker. We contacted
PERS on January 11, 2017 regarding any requirements for PERS Disability Retirees working in a position
with Milton Union EVSD. They informed us that you are required to complete Form #DR-2 (Employment
Review for a Disability Benefit Recipient). You must complete the form, attach copies of Milton Union
Job Descriptions for the positions you have applied for and return to PERS for their approval. We
encourage you to contact PERS for information regarding the impact of working for Milton Union as a
PERS Disability Retiree.

Sincerely,

Kay Altenburger
Treasurer

odt, A,
.E_VAScRai.L.Q.k )7-4-
 MILTON-UNION EXEMPTED VILLAGE SCHOOLS
Board of Education Office
44 7610 Milton-Potsdam Road, West Milton, Ohio 45383 Fax: 937-884-7911
'hone: 937-884-7910 4.
, 11
1 I
Brad Ritchey Ph.D. l' Kay Altenburger
.ij 134,
Superintendent eip Treasurer

January 11, 2017

To Whom It May Concern:

Jerry L. North has applied for Substitute Bus Driver, Substitute Custodian and
Substitute Cafeteria at our school district. Attached are Job Descriptions for these positions with Milton
Union Exempted Village School to attach to his Employment Review for a Disability Benefit Recipient
Application for your review.

if you should need any further information, please do not hesitate to contact me.

Sincerely,

•%?2,(:,'11 /4
Lee A. Pace
Assistant Treasurer
Other member benefits (continued)
4.2.44-ga
r
Disability benefits Retirement System (STRS) and/or School
(continued) Employees Retirement System (SERS), the
disability determination will be made by the
retirement system with the most service credit.
The system with the most service credit will
also pay the benefit. All funds and service
credit in the other system(s) will be transferred
to the paying system.
Eligibility — specific features
For specific plan related eligibility please see
the Disability Benefits leaflet,
Applying for disability benefits under both
disability plans
You are responsible for filing the Disability
Benefit Application along with the Report of
Employer for Disability Benefit Applicant and
Report of Physician.
After we have received all three forms and your
proof of date of birth, you will be required to
have a medical review conducted by OPERS'
third party administrator. OPERS will pay the
fee for this medical review.
For additional information about applying for
disability benefits and what to expect in the
process please see Your Guide to Applying for
an OPERS Disability Benefit available at
www.opers.org.
Receiving disability benefits
Common features
All disability applications are subject to review
by the OPERS Board of Trustees. If the Board
approves your application, your disability
benefit is effective the first day of the month
following the latter of 1) last day for which
compensation was paid, or 2) the attainment of
eligibility.
Prior to payment of a disability benefit,
members participating in the Combined Plan
AV) 0A/}\ (c.14:64. X
must agree to transfer their individual defined
contribution account, employer contributions,
and any amounts paid to purchase service
credit to the Traditional Pension Plan for
the payment of benefits. On such a transfer,
any amounts the member rolled over into
the Combined Plan and any amounts paid
as voluntary deposits will be credited to the
Additional Annuity Program in the Traditional
Pension Plan. All service credit earned under
the Combined Plan is treated as if the credit
was earned or purchased in the Traditional
Pension Plan.
A disability benefit that has been granted,
but has not yet begun, will not be paid if the
member terminates employment then returns
to work with the same employer in the same
position (or another position with similar duties)
as the position the member held at the time the
disability benefit was granted.
Members must terminate public employment by
the end of the month following the month of the
Board's decision. If members do not terminate
public employment within this time frame,
their application will be voided, their disability
benefit will not be paid and will be forfeited.
And, if eligible, members will be required to re-
apply for a disability benefit.
Health care coverage is effective the first day
of the month in which OPERS receives your
disability benefit application or your disability
benefit effective date, whichever is later. Those
with a disability benefit effective date on or
after Jan. 1, 2014, will have access to health
care coverage for the first five years of their
disability based on their continued eligibility
and receipt of a disability benefit during that
time. Please refer to the OPERS Health Care
Coverage Guide regarding eligibility for health
care coverage beyond their first five years.
 Ohio Public Employees Retirement System
OPERS 277 East Town Street, Columbus, Ohio 43215-4642 • 1-800-222-737-7 • Access your OPERS account at www.opers.org

January 20, 2017

Jerry North 3828

Dear Jerry North:

We received y.our employment review request form on January 11, 2017, regarding employment
with Milton-Union Schools (Cafeteria, Custodian and Bus Driver). We have determined the
employment described on your form would not jeopardize your continued receipt of disability
benefits from Ohio PERS.

This determination was made exclusively on the basis of the job duties described in your
request. We do reserve the right to re-evaluate this determination at anytime, it is our
responsibility as a fiduciary of the disability benefit program to review and assess your continued
eligibility to receive disability benefits.

You will need to report any earnings from this position on your annual employment and earnings
statement, as required by Ohio retirement law. We mail these statements the first quarter of
each year, after you have received a disability benefit for one full year.

We advise that you contact the School Employees Retirement System in regards to contributing
to that system while receiving your disability benefit.

If you have any questions, please feel free to contact Member Services at 1-800-222-7377.

Sincerely,

Ohio, P,ERS

18/DBREE1MPOK
 Sub Custodian — Interview questions

Tell me a little about yourself. Past job experience.

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Why are you interested in this position?

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What is your availability? Do you have any reservations working evening hours or weekends?

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 MILTON-UNION EXEMPTED VILLAGE SCHOOLS

File: GDA
TITLE: GROUNDSKEEPER

QUALIFICATIONS: 1. Secondary school graduate.

2. Demonstrated skill in working with all
phases of ground maintenance.
3. Such alternatives to the above qualifications
as the Board may find appropriate and
acceptable.

REPORTS TO: Maintenance Supervisor

JOB GOAL: To perform those duties which contribute to the

highest level of the school operation.

PERFORMANCE RESPONSIBILITIES:

1. Accepts responsibility for the care, conditiOn,

appearance, repair or replacement of the physical
equipment and ground maintenance of all school property;
(example, care and watering of football field).

2. Assists in the promotion of good safety practices and

procedures.

3. Recommends material and supply needs to the Maintenance

Supervisor.

4. Serves as a source of information on area involving the

grounds.

5. Willingly cooperates with building principal, athletic

director, and staff.

6. Uses tack and diplomacy in dealing with students,

parents, and general public.

7. Performs such other duties as may be assigned by

immediate supervisor/administration.

TERMS OF EMPLOYMENT: Salary and work year are to be

established annually by the Master
Contract.

EVALUATION: Performance of this job will be evaluated in

accordance with provisions of the Board's policy
on Evaluation of Classified Personnel.

ADOPTION DATE: April 10, 1989

Milton-Union Schools Performance Appraisal
Classified Staff
PLEASE PRINT North, Jerry

Employee Name; ES Custodian Title

Department

Reason for Review U Annual ❑ Promotion Unsatisfactory Performance

❑ Merit fl End of Probation Period Other

Date employee began present position Date of last appraisal Scheduled appraisal date
Instructions: Carefully evaluate employee's work performance in relation to the essential functions of the job. Check rating box
to indicate the employee's performance. Indicate N/A if not applicable. Assign points for each rating within the scale and write
that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.
Definitions of Performance Ratings
O — Outstanding — Performance is exceptional in all areas I — Improvement Needed — Performance is deficient in
and is recognizable as being far superior to others. certain areas. Improvement is necessary.

V— Very Good — Results clearly exceed most position — Unsatisfactory— Results are generally unacceptable
requirements. Performance is of high quality and is achieved and require immediate improvement.
on a consistent basis.

G — Good — Competent and dependable level of performance. N/A — Not Applicable or too soon to rate.
Meets performance standards of the Job.

General Factors Rating Scale Supportive Details or Comments

1. Quality — The extent to which an employee's O ❑ 4 Points

work is accurate, thorough and neat. V 0 3
G 2
I ❑ 1
U ❑ 0

2. Productivity — The extent to which an O❑ 4 Points

employee produces a significant volume V❑ 3
of work efficiently in a specified period G '51 2
of time. I ❑ 1
U ❑ 0

3. Job Knowledge —The extent to which an 0❑ 4 Points

employee possesses the practical/technical V ❑ 3
knowledge required on the job. G Ei 2
I ❑ 1
U ❑ a

4. Reliability— The extent to which an O❑ 4 Points

employee can be relied upon regarding - V ❑ 3
task completion and follow up. G Egi 2
I ❑ 1
UD 0

5. Attendance — The extent to which an O ❑ 4 Points

employee is punctual, observes prescribed V ❑ 3
work break/meal periods and has an G 0 2
acceptable overall attendance record. I ❑ 1
U ❑ 0
 General Factors Rating Scale Supportive Details or Comments

6. Independence — The extent to which an O 0 4 Points

employee performs work with little or V 0 3
no supervision. G -IR 2
I 0 1
U El 0

7. Creativity — The extent to which an O 0 4 Points

employee proposes ideas, finds new ✓❑ 3
and better ways of doing things. G El 2
I ❑ 1
U ❑ 0

8. Initiative — The extent to which an employee O 0 4 Points

seeks out new assignments and assumes V 0 3
additional duties when necessary. Gig 2
I 0 1
U 0 0

9. Adherence to Policy — The extent to which 00 4 Points

an employee follows safety and conduct rules, V 0 3
other regulations and adheres to company G 2
policies. I 0 1
U ❑ 0

10. Interpersonal Relationships—The extent to O 0 4 Points

which an employee is willing and demonstrates V ❑ 3
the ability to cooperate, work and G 2
communicate with coworkers, supervisors, I 0 1
subordinates and/or outside contacts. U 0 0

11. Judgment — The extent to which an employee O 0 4 Points

demonstrates proper judgment and decision- V 0 3
making skills when necessary. G fl 2
I O 1
U 0 0
Rate employee's overall performance In comparison to position duties and responsibilities. El Outstanding 4
EJ Very Good 3
IN Good 2
O Improvement Needed 1
Total Points ÷ Number of Factors Rated Overall Rating O Unsatisfactory 0
Complete all of the following sections.
1. Accomplishments or new abilities demonstrated since last review

2. Specific areas of needed improvement

3. Recommendations for professional development (seminars, training, schooling, etc.)

4. Absences: Number of incidents ST: - 3 V114_ ir) t g to; 3 Number of days LHOAcrit
Additional Employee Comments

Discussed with individual on Employee's Signature* r ^7-/

is Performance Appraisal was cliscusse me
ackn. e
Follow-up requested/desired 0 Yes 0 No Follow-up Date

Recommend for re-employment Recommend for termination of employment

Evaluator's Signature Date
(PerformanceAppraisalCiassilledstaff 4-11.06)
 1VfiLTON-UNION EXEMPTED VJLLAC-E SCHOOL DISTRICT
NONTEACHING SCHOOL EMPLOYEE'S
LIMITED CONTRACT

1. Employee's Name: 4. Employee's Position:

Jerry North Custo dian

Address: 5. Number of Days/Hours

Per year:
261

2. Date of Board Action: 6. Salary

June 19, 2017 • As Per Salary Schedule

3. Effective Dates of Employment

Under This Contract:
June 5, 2017 for 1 year

THIS IS AN AGREEMENT, by and between the person whose name appears in No. 1, who is
hereinafter referred to as "EMPLOYEE" and the Board of Education of the Milton,Union
Exempted Village School District, pursuant to action duly adopted by the Board of Education on
the date set forth in No. 2.

ti,REAS, the EMPLOYEE has been notified as required by Section 3309.53, Ohio Revised
Code, of his/her duties and obligations under Chapter 3309, Ohio Revised Code, being laws
pertaining to the School Employees Retirement Systems (SERS), and the EMPLOYEE accepts the
provisions of the laws pertaining to the Retirement System as part of this contract and as a
condition of this employment; and,

WHEREAS, the EMPLOYEE's initial assignment under this limited contract shall be as set
forth in No. 4 and 5 subject to reassignment by the Superintendent/designee pursuant to Section
3319.01, Ohio Revised Code,

NOW, THEREFORE, IT IS MUTUALLY AGREED that for the effective dates of

employment set forth in No. 3 the EMPLOYEE is employed by the Milton-Union Exempted
Village School District under a limited contract and that the Board of Education hereby employs the
EMPLOYEE to serve in the position as set forth in No, 4

NOW, THEREFORE, IT IS MUTUALLY AGREED by the Board of Education and the

EMPLOYEE that this agreement may be terminated by a majority vote of the Board of Education
for cause as set forth in Section 3319.081, Ohio Revised Code; and that the EMPLOYEE at his/her
option may terminate the contract thirty days subsequent to his/her filing a written notice of such
termination with the Treasurer of the Board of Education.

IN CONSIDERATION of the salary provided herein, the EMPLOYEE agrees to perform such
duties in connection with his/her employment as may be assigned, to abide by and maintain the
policies, rules and regulations adopted by the Board of Education for the government of its
employees.
 IN CONSIDERATION of such services, the Board of Education shall pay the EMPLOYEE
the Wage Rate as set forth in No. 6 and such other benefits provided by the Board of Education, or
as provided by state law, but subject to the Board's right to uniformly reduce compensation pursuant
to law.

THIS CONTRACT is contingent upon the continuation, at current levels, of any interdistrict
contract or state and/or federal funding which directly supports the position to which the
EMPLOYEE has been assigned.

UNLESS EARLIER, TERMINATED OR SUSPENDED in accordance with law or as set

forth above, this contract shall remain in force as set forth in No. 3.

IN WITNESS WHEREOF, the Board of Education by its Treasurer, has issued and executed
this agreement on the date set forth below and the EMPLOYEE has executed this agreement on the
date set forth below.

Dated this 19th day of June, 2017.

BOARD OF EDUCATION OF THE

MILTON-UNION EXEMPTED VILLAGE
SCHOOL DISTRICT

By em tuf,P -. V64 idi' 41'ee

President

And

By

Employee

NOTE: Employment arrangement of employees, new to the district, is conditional based upon any
content report of Bureau of Criminal Identification and Investigation Federal Bureau of Investigation and
completion of the Declaration Regarding Material Assistance/Non-assistance To A Terrorist Organization.
 MILTON-UNION EXEMPTED VILLAGE SCHOOL DISTRICT
NONTEACBING SCHOOL EMPLOYEE'S
LIMITED CONTRACT

1. Employee's Name: 4. Employee's Position:

Jerry North Custodian

Address:
5. Number of Days/Hours
Per year:
260
2. Date of Board Action:
May 21, 2018 6. Salary
As Per Salary Schedule
3, Effective Dates of Employment
Under this Contract:
July 1, 2018

THIS IS AN AGREEMENT, by and between the person whose name appears in No. 1, who is
hereinafter referred to as "EMPLOYEE" and the Board of Education of the Milton-Union Exempted
Village School District, pursuant to action duly adopted by the Board of Education on the date set
forth in No. 2.

WHEREAS, the EMPLOYEE has been notified as required by Section 3309.53, Ohio Revised
Code, of his/her duties and obligations under Chapter 3309, Ohio Revised Code, being laws
pertaining to the School Employees Retirement Systems (SERS), and the EMPLOYEE accepts the
provisions of the laws pertaining to the Retirement System as part of this contract and as a condition
of this employment; and,

WHEREAS, the EMPLOYEE's initial assignment under this limited contract shall be as set
forth in No. 4 and 5 subject to reassignment by the Superintendent/designee pursuant to Section
3319.01, Ohio Revised Code.

NOW, THEREFORE, IT IS MUTUALLY AGREED that for the effective dates of employment
set forth in No. 3 the EMPLOYEE is employed by the Milton-Union Exempted Village School
District under a limited contract and that the Board of Education hereby employs the EMPLOYEE to
serve in the position as set forth in No. 4

NOW, THEREFORE, IT IS MUTUALLY AGREED by the Board of Education and the

EMPLOYEE that this agreement may be terminated by a majority vote of the Board of Education for
cause as set forth in Section 3319.081, Ohio Revised Code; and that the EMPLOYEE at his/her option
may terminate the contract thirty days subsequent to his/her filing a written notice of such termination
with the Treasurer of the Board of Education.

IN CONSIDERATION of the salary provided herein, the EMPLOYEE agrees to perform such
duties in connection with his/her employment as may be assigned, to abide by and maintain the
policies, rules and regulations adopted by the Board of Education for the government of its
employees.
 IN CONSIDERATION of such services, the Board of Education shall pay the EMPLOYEE the
Wage Rate as set forth in No. 6 and such other benefits provided by the Board of Education, or as
provided by state law, but subject to the Board's right to uniformly reduce compensation pursuant to
law.

THIS CONTRACT is contingent upon the continuation, at current levels, of any interdistrict
contract or state and/or federal funding which directly supports the position to which the EMPLOYEE
has been assigned.

UNLESS EARLIER TERMINATED OR SUSPENDED in accordance with law or as set forth

above, this contract shall remain in force as set forth in No. 3.

IN WITNESS WHEREOF, the Board of Education by its Treasurer, has issued and executed
this agreement on the date set forth below and the EMPLOYEE has executed this agreement on the
date set forth below.

Dated this 21st day of May, 2018.

BOARD OF EDUCATION OF THE

MILTON-UNION EXEMPTED VILLAGE
SCHOOL DISTRICT

B,_,
1 -1
) 4,42 "W a- -
President

And.

Treasurer.

mplo

NOTE: Employment arrangement of employees, new to the district, is conditional based upon any
content report of Bureau of Criminal Identification and Investigation Federal Bureau of Investigation and
completion of the Declaration Regarding Material Assistance/Non-assistance To A Terrorist Organization.
 MILTON-UNION EXEMPTED VILLAGE SCHOOL DISTRICT
NONTEACHING SCHOOL EMPLOYEE'S
LIMITED CONTRACT

1. Employee's Name: 4. Employee's Position:

Jerry North Custodian

Address: 5. Number of Days/Hours

Per year:
261

2. Date of Board Action: 6. Salary

May 18, 2020 As Per Salary Schedule

3. Effective Dates of Employment

Under this Contract:
July 1, 2020— June 30, 2022

THIS IS AN AGREEMENT, by and between the person whose name appears in No. 1, who is
hereinafter referred to as "EMPLOYEE" and the Board of Education of the Milton-Union Exempted
Village School District, pursuant to action duly adopted by the Board of Education on the date set
forth in No. 2.

WHEREAS, the EMPLOYEE has been notified as required by Section 3309.53, Ohio Revised
Code, of his/her duties and obligations under Chapter 3309, Ohio Revised Code, being laws
pertaining to the School Employees Retirement Systems (SERS), and the EMPLOYEE accepts the
provisions of the laws pertaining to the Retirement System as part of this contract and as a condition
of this employment; and,

WHEREAS, the EMPLOYEE's initial assignment under this limited contract shall be as set
forth in No. 4 and 5 subject to reassignment by the Superintendent/designee pursuant to Section
3319.01, Ohio Revised Code.

NOW, THEREFORE, IT IS MUTUALLY AGREED that forthe effective dates of employment

set forth in No. 3 the EMPLOYEE is employed by the Milton-Union Exempted Village School
District under a limited contract and that the Board of Education hereby employs the EMPLOYEE to
serve in the position as set forth in No. 4

NOW, THEREFORE, IT IS MUTUALLY AGREED by the Board of Education and the

EMPLOYEE that this agreement may be terminated by a majority vote of the Board of Education for
cause as set forth in Section 3319.081, Ohio Revised Code; and that the EMPLOYEE at his/her option
may terminate the contract thirty days subsequent to his/her filing a written notice of such termination
with the Treasurer of the Board of Education.

IN CONSIDERATION of the salary provided herein, the EMPLOYEE agrees to perform such
duties in connection with his/her employment as may be assigned, to abide by and maintain the
policies, rules and regulations adopted by the Board of Education for the government of its
employees.
 IN CONSIDERATION of such services, the Board of Education shall pay the EMPLOYEE the
Wage Rate as set forth in No. 6 and such other benefits provided by the Board of Education, or as
provided by state law, but subject to the Board's right to uniformly reduce compensation pursuant to
law.

THIS CONTRACT is contingent upon the continuation, at current levels, of any interdistrict
contract or state and/or federal funding which directly supports the position to which the EMPLOYEE
has been assigned. -

UNLESS EARLIER TERMINA'IED OR SUSPENDED in accordance with law or as set forth

above, this contract shall remain in force as set forth in No. 3.

IN WITNESS WHEREOF, the Board of Education by its Treasurer, has issued and executed
this agreement on the date set forth below and the EMPLOYEE has executed this agreement on the
date set forth below.

Dated this 18th day of May, 2020.

BOARD OF EDUCATION OF THE

MILTON-UNION EXEMP'IED VILLAGE
SCHOOL DISTRICT

By
President

And

By

Employee

NOTE: Employment arrangement of employees, new to the district, is conditional based upon any
content report of Bureau of Criminal Identification and Investigation Federal Bureau of Investigation and
completion of the Declaration Regarding Material Assistance/Non-assistance To A Terrorist Organization.
 MILTON-UNION EXEMPTED VILLAGE SCHOOL DISTRICT
NON1EACHING SCHOOL EMPLOYEE'S
LIMDED CONTRACT

1. Employee's Name: 4. Employee's Position:

Jerry North Custodian

Address: 5. Number of Days/Hours

Per year:
261

2. Date of Board Action: 6. Salary

May 16, 2022 As Per Salary Schedule

3. Effective Dates of Employment

Under this Contract:
July 1, 2022 — June 30, 2024

THIS IS AN AGREEMENT, by and between the person whose name appears in No. 1, who is
hereinafter referred to as "EMPLOYEE" and the Board of Education of the Milton-Union Exempted
Village School District, pursuant to action duly adopted by the Board of Education on the date set
forth in No. 2.

WHEREAS, the EMPLOYEE has been notified as required by Section 3309.53, Ohio Revised
Code, of his/her duties and obligations under Chapter 3309, Ohio Revised Code, being laws
pertaining to the School Employees Retirement Systems (SERS), and the EMPLOYEE accepts the
provisions of the laws pertaining to the Retirement System as part of this contract and as a condition
of this employment; and,

WHEREAS, the EMPLOYEE's initial assignment under this limited contract shall be as set
forth in No. 4 and 5 subject to reassignment by the Superintendent/designee pursuant to Section
3319.01, Ohio Revised Code.

NOW, THEREFORE, IT IS MUTUALLY AGREED that for the effective dates of employment
set forth in No. 3 the EMPLOYEE is employed by the Milton-Union Exempted Village School
District under a limited contract and that the Board of Education hereby employs the EMPLOYEE to
serve in the position as set forth in No. 4

NOW, THEREFORE, IT IS MUTUALLY AGREED by the Board of Education and the

EMPLOYEE that this agreement may be terminated by a majority vote of the Board of Education for
cause as set forth in Section 3319.081, Ohio Revised Code; and that the EMPLOYEE at his/her option
may terminate the contract thirty days subsequent to his/her filing a written notice of such termination
with the Treasurer of the Board of Education.

IN CONSIDERATION of the salary provided herein, the EMPLOYEE agrees to perform such
duties in connection with his/her employment as may be assigned, to abide by and maintain the
policies, rules and regulations adopted by the Board of Education for the government of its
employees.
 IN CONSIDERATION of such services, the Board of Education shall pay the EMPLOYEE the
Wage Rate as set forth in No. 6 and such other benefits provided by the Board of Education, or as
provided by state law, but subject to the Board's right to uniformly reduce compensation pursuant to
law.

THIS CONTRACT is contingent upon the continuation, at current levels, of any interdistrict
contract or state and/or federal funding which directly supports the position to which the EMPLOYEE
has been assigned.

UNLESS EARLIER lERMINNIED OR SUSPENDED in accordance with law or as set forth

above, this contract shall remain in force as set forth in No. 3.

IN WITNESS WHEREOF, the Board of Education by its Treasurer, has issued and executed
this agreement on the date set forth below and the EMPLOYEE has executed this agreement on the
date set forth below.

Dated this 16th day of May, 2022.

BOARD OF EDUCATION OF THE

MILTON-UNION EXEMPTED VILLAGE
SCHOOL DISTRICT

Treasurer

Employee

NOTE: Employment arrangement of employees, new to the district, is conditional based upon any
content report of Bureau of Criminal Identification and Investigation Federal Bureau of Investigation and
completion of the Declaration Regarding Material Assistance/Non-assistance To A Terrorist Organization.
 MILTON-UNION EXEMPTED VILLAGE SCHOOLS

CLASSIFIED EMPLOYEES

ONE YEAR LIMITED CONTRACT FOR SUBSTITUTE EMPLOYEE

AN AGREEMENT entered into between Jerry North of West Milton, OH hereinafter

referred to as "SUBSTITUTE EMPLOYEE" and the Milton-Union Exempted Village Board of

Education of Miami County, Ohio,' hereinafter referred to as "BOARD", witnesseth:

The said "SUBSTITUTE EMPLOYEE" hereby agrees to work in the Milton-Union

Schools for the school year 2020-2021.

The said "SUBSTITUTE EMPLOYEE" further agrees to abide by and maintain the rules

and regulations adopted by said "BOARD" for the government of the Milton-Union Schools.

IN CONSIDERATION of and for such services, the said "BOARD" agrees to pay, at the

office of its Treasurer, to the said "SUBSTITUTE EMPLOYEE" as per salary schedule.

ENTERED INTO at West Milton, Ohio, this 8th day of February, 2021.

Substi Emp ee

Date Signed

THE BOARD OF EDUCATION

Milton-Union Exempted Village Schools

By S
President

NOTE: Employment arrangement of employees, new to the district, is conditional based upon any content report of
Bureau of Criminal Identification and Investigation, Federal Bureau of Investigation, and completion of the Declaration
Regarding Material Assistance/Non-assistance To A Terrorist Organization form.
 MILTON-UNION EXEMPTED VILLAGE SCHOOLS

CLASSIFIED EMPLOYEES

ONE YEAR LIMITED CONTRACT FOR SUBSTITUTE EMPLOYEE

AN AGREEMENT entered into by and between. Jerry North of West Milton, OH

hereinafter referred to as "SUBSTITUTE EMPLOYEE" and the Milton-Union Exempted Village

Board of Education of Miami County, Ohio, hereinafter referred to as "BOARD", witnesseth:

The said "SUBSTITUTE EMPLOYEE" hereby agrees to work in the Milton-Union

Schools for the school year 2018-2019.

The said "SUBSTITUTE EMPLOYEE" further agrees to abide by and maintain the rules

and regulations adopted by said "BOARD" for the government of the Milton-Union Schools.

IN CONSIDERATION of and for such services, the said "BOARD" agrees to pay, at the

office of its Treasurer, to the said "SUBSTITUTE EMPLOYEE" as per salary schedule.

ENTERED INTO at West Milton, Ohio, this 171 day of September, 2018.

Date Signed

THE BOARD OF EDUCATION

Milton-Union Exempted Village Schools

By

NOTE: Employment arrangement of employees, new to the district, is conditional based upon any content report of
Bureau of Criminal Identification and Investigation, Federal Bureau of Investigation, and completion of the Declaration
Regarding Material Assistance/Non-assistance To A Terrorist Organization form.
 MILTON-UNION EXEMPTED VILLAGE SCHOOLS

CLASSIFIED EMPLOYEES

ONE YEAR LIMITED CONTRACT FOR SUBSTITUTE EMPLOYEE

AN AGREEMENT entered into between Jerry North of West Milton, OH hereinafter

referred to as "SUBSTITUTE EMPLOYEE" and the Milton-Union Exempted Village Board of

Education of Miami County, Ohio, hereinafter referred to as "BOARD", witnesseth:

The said "SUBSTITUTE EMPLOYEE" hereby agrees to work in the Milton-Union

Schools for the school year 2017-18.

The said "SUBSTITUTE EMPLOYEE" further agrees to abide by and maintain the rules

and regulations adopted by said "BOARD" for the government of the Milton-Union Schools.

IN CONSIDERATION of and for such services, the said "BOARD" agrees to pay, at the

office of its Treasurer, to the said "SUBSTITUTE EMPLOYEE", salary as determined by the

adopted salary schedule for the job assignment fulfilled.

ENTERED INTO at West Milton, Ohio, this 18th day of September, 2017.

Date Signed

THE BOARD OF EDUCATION

Milton-Union Exempted Village Schools

By
eerseee
President

NOTE: Employment arrangement of employees, new to the district, is conditional based upon any content report of
Bureau of Criminal Identification and Investigation, Federal Bureau of Investigation, and completion of the Declaration
Regarding Material Assistance/Non-assistance To A Terrorist Organization form.
 BMV Driver info
Printed by: Milton-Union Exempted Village
Confidentiality and Non-disclosure of Information

User agrees that they shall not use or re-disclose any information, systems or records made available to them through ODE or the Ohio BMV for
any purpose other than to fulfill statutory or legal obligations or other use specified hereln.User specifically agrees to be bound by standards of
confidentiality and non-disclosure that apply to political subdivisions, governmental agencies, and the State of Ohlo.User specifically agrees to comply
with state and federal confidentiality laws and regulations applicable to the information obtained through use of this program,User is responsible for
obtaining copies of all applicable rules governing confidentiality, re-disclosure, and for assuring compliance with the laws and rules covering the
Information obtained through use of this service.

Search CDL: FIND MAIN MENU SHOW ALL

. . ,. _ .
DRIVER CDL CDL CDL CDL Endorsements Record Offense Offense Conviction Ohio Accident Suspension Suspension
NAME/DOB Class Expiration Status Type Type Date Date Points Date Start End
Date Date
- •
rl Operator DB12312017 VALID NONE

https://sfps.ode.state.oh.us/SFPS/Transportation/Driver/BMV_Driversinfo.aspx?ed1=-IpZV... 2/17/2017
 SPECIMEN ID Nb.
CLINICAL .REFERENCE®
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8433 OUIVIRk<ENEXA, KANSAS 66215
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A. Employer Name, Address, I.D. No. - , • B. MRO •NaTer Address, Phohe and Fax No. • • Is
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• COPY 4 - EMPLOYER COPY V1.7 05/16

 . . . ir mom:.iroIffy&ti aimeinent :4M; '
Public Burden Statement: An agency may not candUct or sponsor, and a per0-iii..:, ts.Aot, re. tired .to respond to, a
collection of information unless it displays a currently valid OMB control number. The'ictiMB Control 'nUmber for this project is
0930-0.158. Public reporting burden far this collection of information is estimated ti:Oera0 5 :n...iiiinte'Sfddripi,":4minutes/collector,
3 minutes/test facility, and 3 minutes/Medical Reviw Officer. Send comments, regarding this burden estimate or any other. aspect .
of this collection information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke
Cherry Road, Room,77•1044,.Rpolgille, , klaryland.2057,.,, .

..•
• ".--•• P Yr.! • • . .
•
MADISON
Ohio Department of Education Pupil Transportation Section

Ohio Pre-Service School Bus Driver Training Enrollment Form

Effective on classes 2/1/16 & after
Date: 'a\ \
$85.00 for each New Driver
To: Evette Moody, West Region $60.00 for each Recertified Driver
Pre-Service Instructor, Madison-Champaign ESC TRAiNiN
Attn: Pre-Service Dept ■ 2200 US Hwy 68 Urbana, OH 43078
(p) 937-484-1557 (f) 937-14014571

From: JokY\ Cec,,55 of Imo". CI,ohransportation Dept.

(Transportation Supervisor) (School District)

Phone #: 1\31 -1.oC2)^,3 4-M0 Fax #: 1ST - Zgli

(Transportation #) (Transportation Fax it)

THE FOLLOWING DRIVERS ARE TO ATTEND THE C k OkYNNepii\°) VN

tAleA CLASS
(Loc)ion of Class)
ON Cc-6 zo -23 20n
(Dates)
New Drivers (All Pre-Service Sessions) Recertification Drivers (Sessions 2, 3, & 4 only)
L:edirk4 00,N

Options for Pre-Service Payments:

Prepay w/ credit card by contacting Amber LeValley at 937-484-1557. Please note there is a $2.00 credit
card, processing fee.
Prepay by check or money order payable to Madison-Champaign ESC
Bill District with or without Purchase Order (PO#). If using a PO, please provide that # here: //fi°0
Billing Address:
• Class Registration Forms not received 2 butiness days prior to class will not be accepted.
• Cancellations not received within 2 business days prior to class will be billed in FULL for the class, this
includes no-shows.
• Drivers will not be permitted in class if they are not pre-registered.
• The school district sending the driver to class is responsible for class fees unless otherwise stated by the
district itself.
TRUE
 Driver/Employer T8 Form
Ohio. .Dopartment
of Education
School Transportation Driver Medical Form
1-8
Rev. 3/2012

, . a, ( .

A. To be Completed by Applicant (Print or Type)

Last Name First Name MI

.3-15Riv,i
NO12\714- L.
Home Address City/State/Zip

CDL Number State CDL Expiration Date DOB

J24 `
.111
Most Recent Preservice Date: Month Year Preservice Certificate #

I hereby release the information on this form to the constituted authorities for evaluation purposes.

Driver/Applicant Signature:

• • ' '., i f• "'

B. To be Completed by Employer (Print or Type)

School District Name/Contractor Name

A//-7"0N -&-MON L/7/Pri) Oa 4(5- . _1?//W..

District IRN County Contractor License Number

N5Sig W

Most Recent District Inservice Date:

This Individual Will Be Employed to Operate: dS •chool Bus School Van

Date Signature of Bus Owner/Designee Printed/Typed Name

• , = s.: .,..„ , q .,
, .

Special Instructions for Blood Pressure Checks:

If the doctor has circled P-90 day on the physical form, the T8 expires in 9O days unless the driver obtains a blood
pressure reading at 90 days. This reading must be recorded on the T8 form.

An additional blood pressure must be taken at 6 months, recorded on the T8 form and reported to ODE on the
web-based reporting system.

THIS FORM MUST BE ATTACHED TO THE PHYSICIAN'S T8 FORM TO BE VALID

North, Jerry
7145 S Kessler Frederick Rd
West Milton, OH 45383
937-232-3820 DOB: 8/23/1963
Co ID-MILUNSCH DATE: 02-13-2017
 Physician's T8 Fl North Jer

Form 1.8 Ohio Department of Education Driver: FN

Revised 3/2012 School Transportation Driver Medical Form Co ID-MILUNSCH DATE: 02-13-2017
•
1 Has no loss of a foot, a leg, a hand, or an arm.
2 Has no impairment of the use of a foot, a leg, a hand, fingers, or an arm and no other structural
defect • Missing Ilmb waiver required
or limitation which is likely to interfere with a person's ability to control and safely operate a school bus.
3 Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin
for control. ** Annual urinalysis screening for glucose is required. If glucosuria is detected, a physician's II Insulin waiver required
statement regarding the potential condition of diabetes mellitus and any required treatment is to be • slucosuria Stmt attached
attached.
4 Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency,
thrombosis,
or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, D Cardiovascular stmt
or congestive cardiaefailure. A person with a history of cardim)asculapsufgery or abnormality shall be given
a more stringent examination (example: stress testing, Halter monitoring, angiography or other examinations)
to determine whether or not the surgery or abnormality is likely to impair a person's ability to control, inspect,
and safely operate a school bus. If it is determined the surgery or abnormality is not•likely tp impair the
ability, the examining physician will provide certificationAd that,effeawitli the'exarrilnatidn report. , ,..
Individuals with an implanted defibrillator may not operate a school transportation vehicle.
5 Has no history of transient ischemic attack (TIA), carotid insufficiency, cerebra( vascular accidents
(stroke)
or other vascular abnormalities which are unstable or uncontrolled and/or likely to interfere with a person's
ability to control and safely operate a school bus.
6 Has no establighed-fmedical histOry &clinical diagnosis of a respiratory dysfunction likely to inte"rfere with a
person's ability to control and safely operate a school bus.
7 Please record BP in margin where indicated.
Mit!
Blood Pressure at or below 160/90 is passing.
B/P

If initial BP is 161-180 systolic and/or 91-104 diastolic a non-renewable 90 day T-8 may be issued.
,.., 90 day reading
Blood pressure must be checked again in 90 days and musfte at or D8i0W.160190, If not, t driver
. B/P I
is disqualified. Driver must be checked again within 6 months, and must be at or below 160/90.
6 month reading
Date
Blood Pressure exceeding 180 systolic or 104 diastolic is failing.
B/P
8 Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular or
neuromuscular disease which is likely to interfere with a person's ability to control and safely operate
a school bus.
9 Has no established medical history or clinical diagnosis of epilepsy or any other seizure disorder and
has
no other condition which is likely to cause loss of consciousness or any loss of a person's ability to control
and safely operate a school bus.
10 Has no mental, emotional, nervous, organic or functional disease or psychiatric disorder which is likely to
interfere with a person's ability to control and safely operate a school bus.
11 Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity
separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least
20/40 (Snellen) In both eyes with or without corrective lenses, field of vision of at least seventy degrees
in
the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices
showing standard red, green, and amber. Persons may use corrective lenses to attain these standards.
12 Screening audiometer test does not indicate an average hearing loss in the better ear greater
than 40
decibels at 500 Hz, 1000 Hz, and 2000 Hz with or without a hearing aid when the audiometric device is
calibrated to "American National Standard" (formerly ASA standard) Z24.5
(Hearing in at least one ear must meet the preceding criteria.)
13 Has no current clinical evidence or clinical record of use of illegal substances and has no current clinical
evidenCe or clinical record of use of legally prescribed medication which Is likely to interfere with a person's
ability to control and safely operate a school bus.
14 Has no recent history of alcohol abuse and has no current clinical diagnosis of alcoholism.
15 Has no neurologic deficit that would impair a person's ability to control and safely operate a school bus.
16 Does not show clinical evidence of active pulmonary tuberculosis or other communicable diseases.
17 Has the speech capabilities to give clear and understandable directions or commands.

I hereby certify that the above applicant has been examined by me in accordance with the A conditionally
the medical requirements for school transportation drivers as contained on this form.
I have also reviewed the physical activities that the school transportation driver/applicant El Applicant passes conditionally-missing limb waiver
may be required to perform Ej Applicant passed conditionally - insulin waiver required

13-I teA i° El Applicant does not meet these standards

❑ Incomplete - does not meet these standards
Date Pbysi is ignature State Board No ck

This form must be attached to the Driver 1Employer TB form to be valid

Board of Education Office
7610 Milton-P,otsdam Road, West Milton, Ohio 45383
Phone: 937-884-7910 Fax: 937-884-7911
www.muschools.com

April 24, 2023

Mr. Jerry North

'0IIIA 1331duma
RE: Paid Administrative Leave

Dear Mr. North:

You are hereby placed on administrative leave with pay, effective immediately, pending further investigation into
matters relating to your employment.

You are immediately suspended from any and all work duties. You are not authorized to undertake, and may not
engage in, any activities on behalf of the Milton Union Local School District ("the District") unless specifically
instructed to do so by me. You may not represent to others that you have any authority to act on behalf of the
District. During this period of administrative leave, you are directed to remain at home and provide us with a
telephone number where you can be immediately reached during your normal work hours.

Until further notice, you are not to return to any property owned or used by the District or attend any District
functions unless specifically authorized or requested to do so by me. To that end, you are required to immediately
relinquish your District keys and fobs, passwords, and codes to me. If you have District property at home, we will
send a representative to pick it up. If you need to retrieve any personal belongings from work, you should provide
a list of those items to me, and I will arrange for their delivery to you.

You are instructed to refrain from having any contact with District students or their parents/guardians until further
notice. You are not to communicate with other District employees during their normal work hours unless
specifically authorized by me. Further, you are directed to preserve, unchanged, any District-related
communications and property in your possession, including any communications you have sent persons who are
not employed by the Milton Union Local Schools Board of Education.

This period of paid administrative leave and the directives set forth above will continue until I issue written notice

(continued)

District Administration Board of Education

Brad Ritchey, Ph.D. 1 Superintendent Lori Ginn Parsons I President
David Stevens I Treasurer Linda Hinkehnan I Vice President
Katie Hartley I Director of Curriculum & Instruction Jessica Brumbaugh
Laurie Grube I Director of Student Services Justin Cress
Mick Nealeigh I Director of Technology Ben Dehus
Dan Baisden I Operations Manager
 North, J. — Administrative Leave — 4.24.2023

to you stating otherwise. Please note that this administrative leave is not a disciplinary action or adverse
employment action. You will be notified of any change in your status. You should direct any questions you may
have about your status to my attention.

Respectfully,

8 11 7

Brad Ritchey, Ph.D.

cc: Ramona Grossman — OAPSE President

North, J. — personnel file
 Milton-Union Exempted Village Schools
Board of Education Office
7610 Milton-Potsdam Road, West Milton, Ohio 45383
Phone: 937-884-7910 Fax: 937-884-7911
www.muschools.com

May 4, 2023

Mr. Jerry North

Mr. North:

Effective immediately, you are being placed on an unpaid leave of absence pursuant to R.C. 3319.40 as
a result of your arrest and the criminal charges filed against you yesterday in the Miami County
Municipal Court.

You are relieved of any and all duties associated with your position as an employee of the Milton Union
Exempted Village Schools during the pendency of the criminal actions against you. You shall not
represent that you have any authority to act on behalf of the District. You are not to be on District
property during the pendency of your criminal charges or attend District events without my personal
written permission and supervision. Finally, you are instructed to keep me apprised of the status of your
criminal proceedings as they proceed.

Please direct any questions you may have to my attention.

Sincerely,

PthIP 7
Brad Ritchey

District Administration Board of Education

Brad Ritchey, Ph.D. I Superintendent Lori Ginn Parsons I President
David Stevens I Treasurer Linda Hinkehnan I Vice President
Katie Hartley I Director of Curriculum & Instruction Jessica Brumbaugh
Laurie Grube I Dii.ector of Student Services Justin Cress
Mick Nealeigh I Director of Technology Ben Dehus
Dan Baisden I Operations Manager