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Date___________________
PERSONAL:
Name_________________________________
SS#________________________
Present
Address_____________________________________________________
Permanent
Address___________________________________________________
Home
Phone#_____________________ Work Phone#______________________
Have
you ever been convicted of a felony?__________If so,
what?_______________
EMPLOYMENT
DESIRED: ______________________________________________________
Custodial
_____________ Maintenance _______________ Either
____________
List
any special skills you possess: (Example: Electrical, Plumbing,
Carpentry, etc.)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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EDUCATION: |
Name
of School |
#
Years Attended |
Graduated
Yes \ No |
Major
Field |
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High
School |
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College
or University |
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College
or University |
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AVAILABILITY
Date
you can start________________ Are you employed now?_________________
If
so, may we inquire of your present
employer?______________________________
May
we contact other references prior to an
interview?________________________
FORMER
EMPLOYERS: Please list below your last four employers
(most recent one first).
|
Month/Year |
Name/Address
of Employer |
Home
Phone |
Work
Phone |
Position
Held |
Reason
for Leaving |
|
From
To |
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From
To |
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From
To |
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From
To |
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REFERENCES:
Give below the names of three persons not related to you whom you
have known at least one year (preferably
in the teaching profession).
|
Name |
Address |
Phone
# |
Occupation |
Years
Acquainted |
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CERTIFICATION:
I hereby certify that the information given by me in this
application is true, correct and complete; and I hereby authorize
personnel in the district to examine my records and contact any of
my schools, former employers or other references for the purposes of
collecting information regarding my employment, education,
experience and fitness as an employee. I authorize such references
to disclose information regarding my employment, education,
experience and fitness as an employee, and I agree to hold any and
all of such references harmless and free of any liability for
releasing any truthful information about me.
I understand that if I am employed, any false or misleading
statement made or implied on this application, any omission herefrom,
or any inconsistency between the information I have provided herein
and information obtained from any criminal history records check,
Statewide Sex Offender Database check, Statewide Child Murderer and
Violent Offender Against Youth Database check, or background
investigation is sufficient cause for dismissal.
____________________________________
___________________________
Signature Date
APPLICATIONS
REMAIN ACTIVE FOR ONE YEAR-REAPPLICATION IS NECESSARY
AFTER THAT
TIME
Do
not write below this line
Date
of Interview____________ Time___________ Interviewed
by:_____________
Remarks__________________________________________________________
_________________________________________________________________
_________________________________________________________________
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