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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: ________________________________________________
Drivers
License #:_________________________ State: __________
CDL
- Date:___________ Rating:____________ Class:___________
Have
you had any driving violations in the Past 5 Years while using your
CDL?_______
Comments:_________________________________________________________
__________________________________________________________________
__________________________________________________________________
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EDUCATION: |
Name
of School |
#
Years Attended |
Graduated
Yes \ No |
Major
Field |
|
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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|
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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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|
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AFFIRMATION:
I
hereby affirm that the information given by me in this application
is true and complete to the best of my knowledge; and,
I hereby grant permission to authorize personnel in the district the
right to examine my records for the purpose of hiring.
I understand that any misrepresentation, falsification, or omission
will be sufficient cause for cancellation of the application,
or discharge if I have been employed and may constitute a Class A
misdemeanor.
______________________________________
________________________
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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