Andes Central School Certified/Administrative Employment Application

Andes Central School District

1001 High St., Lake Andes, SD 57356 ~ (605) 487-7671 ~ www.andescentral.k12.sd.us "Doing Whatever It Takes For High Flying Success"
Application Information

Application for Certified & Administrative Positions
Full Name*

Last NameFirst NameMiddle Initial
Date*

MonthDayYear
Date
Mailing Address*

Physical Address/Mailing Address

PO Box

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email Address*
Date available for employment*
Position for which you are applying*
Education
High School*
Address*
Dates of attendance*
Did you graduate?*
If yes, did you receive a diploma?*
For Undergraduate
Begin with most recent undergraduate school*
For Graduate
Begin with most recent graduate school*
Employment History for Last 7 Years
Begin with most recent employer*
References

Please list three professional references (not related to you) who are familiar with your work.
Reference #1: Full Name*
Relationship*
Job Title*
Phone*
Address*
Email*
Reference #2: Full Name*
Relationship*
Job Title*
Phone*
Address*
Email*
Reference #3: Full Name*
Relationship*
Job Title*
Phone*
Address*
Email*
Other Information
1. Are you claiming veterans' preference?*
If yes, indicate branch and discharge date.*
2. Males born after December 31, 1959 are required to register with the Selective Service. Are you registered with the Selective Service?*
3. Are you a citizen of the United States?*
If no, can you work in the United States legally?*
4. Have you ever been asked to resign from a position?*
5. Are you at least 18 years old?*
6. Have you ever been convicted of a crime including sex-related or abuse related offenses?*
If yes, please explain.*
7. Have you ever been convicted of a violation of law other than a minor traffic violation? (The term "conviction" includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgement, or a finding of guilt or by a jury or judge.)*
If yes, please describe in detail below:*
8. Are you willing to submit to a background check?*
9. Are you certified to teach in South Dakota?*
If yes, please provide certificate number and expiration date*
If no, when will you have your certificate to teach in South Dakota?*
10. Have you ever been the subject of a complaint or have you been disciplined by a court or licensing board of any state?*
If yes, please explain*
11. Has there been any incident that could negatively impact your position within the Andes Central School District?*
If yes, please explain*
12. Are you currently under contract with another district?*
If yes, indicate the date you will be available to begin employment with the Andes Central School District.*
Upload Supporting Documents*

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Disclaimer and Signature
                The statements made and information given in this application are to the best of my knowledge true, accurate, and complete. I understand information in this application is subject to verification by the Andes Central School District #11-1 and hereby grant permission for such verification. If during verification the stated responses are determined to be false, any consideration for employment will be immediately terminated.

                ***All offers of employment are contingent on the results of a background check. If no South Dakota statutorily disqualifying conviction is identified at the state level, fingerprints will be forwarded by SD DCI to the FBI for a national criminal history record check. If an applicant believes the criminal background result is incorrect or incomplete, the application may challenge the accuracy or completeness of the record by contacting FBI, Criminal Justice Information Services Division, ATTN: SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306.

                The Andes Central School District does not discriminate its employment practices based on gender, race, national origin, color, disability, or age.
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Andes Central School District

Application Information

Education

For Undergraduate

For Graduate

Employment History for Last 7 Years

References

Other Information

Disclaimer and Signature