Certified Staff Application Form

Certified Staff Application Form
NAME
Birthdate

MonthDayYear
Date
HOME ADDRESS
HOME PHONE
BUSINESS PHONE
CELL PHONE
E-MAIL ADDRESS
example@example.com
For what position are you applying?
DATE OF APPLICATION

MonthDayYear
Date
EDUCATIONAL DATA
High School
Date of Graduation

MonthDayYear
Date
College/Technical School training in chronological order:
College/Technical School -- Location -- Dates -- Degree/Hours -- Major
College/Technical School -- Location -- Dates -- Degree/Hours -- Major
College/Technical School -- Location -- Dates -- Degree/Hours -- Major
College/Technical School -- Location -- Dates -- Degree/Hours -- Major
Professional Data
Current Employer
Exact type of certificate/license you currently hold
Date of Expiration

MonthDayYear
Date
Work Experience Relating to Position Applying For:
Position & Date
Reference & Phone Number
Position & Date
Reference & Phone Number
Position & Date
Reference & Phone Number
Physical Limitations, if any: (Please list)
Other Work Experience (Please list and give dates of employment)
Position & Date Reference
Reference & Phone Number
Position & Date Reference
Reference & Phone Number
Position & Date Reference
Reference & Phone Number
Other Work Experience
Employer -- Location -- Dates -- Duties
Employer -- Location -- Dates -- Duties
Employer -- Location -- Dates -- Duties
Employer -- Location -- Dates -- Duties
List Three Professional or Employer References:
Name
Address/Phone Number
Name
Address/Phone Number
Name
Address/Phone Number
Is it permissible to contact the above references?
If no, what date will contacts be permissible?
Have you had any limitations that will not allow you to do heavy lifting, sitting/standing for lengthy periods, computer work for lengthy periods or any other work related to the secretarial position?
If yes, please explain
CANDIDATES EDUCATIONAL STATEMENT
Please provide a brief narrative statement concerning your knowledge of, or experience in each of the following areas: (Use additional paper as needed)
1. Classroom/Group management skills:
2. Technology usage skills
3. What special talents or skills would you bring to USD #430?
APPLICANT JOB APPLICATION ACKNOWLEDGEMENTS
I certify that all the information provided by me in this application is true and complete. I understand that any mis- statement, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is dis- covered thereafter, termination.

I authorize any of the persons or organizations referenced in this application to give you any and all information con- cerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damages that may result from furnishing such information to you. I authorize any background checks by any third party.

I authorize you to request, receive, and verify all information given on this application and I release you from all dam- ages that may result from your doing so.

I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete such investigation, and I release you from all liability for any damages that may result from your doing so.
Signature of Applicant Applicant's

Clear
Date

MonthDayYear
Date
Applicants for admission and employment, students, parents of elementary school students, employees, source of referral of ap plication for admission and employment, and all unions or professional organizations holding collective bargaining on the basis of race , color, national origin, sex, age or handicap in admission or access to, or treatment or employment in its programs and activities. Any person having inquiries concerning Unified School District #430 compliance with the regulations implementing Title VI, Title IX, or Section 504 are directed to contact the Superintendent, 522 Central Avenue, Horton, Kansas 66439, 785-486-2611. The Superintendent has been designated by Unified School District #430 to coordinate the institution’s efforts to comply with the regulations implementing Title VI, Title IX and Section 504. Any person may also contact the Assistant Secretary of Civil Right, U.S. Department of Education, regarding the institution’s compliance with the regulations implementing Title VI, Title IX, or Section 504.
File Upload

Cancelof
Should be Empty:

Certified Staff Application Form

EDUCATIONAL DATA

Professional Data

Other Work Experience

CANDIDATES EDUCATIONAL STATEMENT

APPLICANT JOB APPLICATION ACKNOWLEDGEMENTS