Waldron Public Schools Certified Employment Application

Waldron Public Schools Certified Employment Application
Name: *

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

Month Day Year
Phone Number: *

Area Code Phone Number
E-mail Address:
Complete Mailing Address: *

Street Address

Street Address Line 2

City State / Province

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

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

Yes No
In Case of Emergency, Notify
Upload Resume: (if applicable)
References Please list two (3) references that are familiar with your work life.
Reference 1
Name: *

First Name Last Name
Phone Number *

Area Code Phone Number
Years Known: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reference 2
Name: *

First Name Last Name
Phone Number *

Area Code Phone Number
Years Known: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reference 3
Name

First Name Last Name
Phone Number

Area Code Phone Number
Years Known: *
Address *

Street Address

Street Address Line 2

City State / Province

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

Yes No
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

Month Day Year
Date
Should be Empty: