Waldron Public Schools Certified Employment Application

Waldron Public Schools Certified Employment Application
Name:*

First NameLast Name
What Position Are you Applying for:
Social Security Number
Birth Date

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail Address:
Complete Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a U.S. Citizen

YesNo
If you answered No- are you a legal alien?
Have you ever been convicted of a felony?

YesNo
In Case of Emergency, Notify
Upload Resume: (if applicable)

Upload a File

Cancelof
References Please list two (3) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 3
Name

First NameLast Name
Phone Number

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you hold an Arkansas Teaching Certificate?

YesNo
Expiration Date
Subjects Qualified to Teach as listed on Certificate
AGREEMENT

I authorize the investigation of all statements contained in this application. I understand misrepresentation or omission of facts called for is cause for dismissal without notice at any time during my employment. I agree, if employed, to follow all rules and regulations of the district. I understand by State Law the Board of Education must require all employees to submit a one-time chest x-ray or tuberculin test. I further understand and agree the x-ray and tuberculin test will be at my expense. I agree to promptly notify the district if any change of address during my employment.
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty: