USD 112 CENTRAL PLAINS

USD 112 CENTRAL PLAINS
EMPLOYMENT APPLICATION NON-CERTIFIED PERSONNEL
Date

MonthDayYear
Date
Name (First Last)
ADDRESS, City, State
HOME TELEPHONE
Format: (000) 000-0000.
BUSINESS TELEPHONE
Format: (000) 000-0000.
Email
example@example.com
Are you over the age of 18?
SPECIFIC POSITION(S) APPLIED FOR
EDUCATION
SCHOOL NAME LOCATION DATES ATTENDED DIPLOMA OR DEGREE
High School Attended
College or University Attended
Business or Trade
Other
WORK EXPERIENCE
List work experience with dates, number of years, name & address of employment, supervisor's name, and job title:
Do you have any relatives who work for USD112 Central Plains or who serve on the Board of Education? yes no If yes, please state their names and your relationship
Have you ever been convicted of or pled guilty or nolo contendre to a felony or any offense involving moral turpitude? yes no If yes, please explain: Moral turpitude is an act of baseness meanness, vileness evil or depravity corruption in the private and social duties which a person owes another member of society or society in general and which is contrary to the accepted rule of right and duty between persons, including, but not limited to theft, attempted theft, murder, rape, swindling and indecency with a minor. Conviction of a crime is not an automatic bar to employment
USD 112 CENTRAL PLAINS
Why are you seeking to change positions or why did you leave your last position?
Have you ever been dismissed or asked to resign from employment? If yes, please explain
Are you aware of any reason you would not be able to perform the duties required of the position for which you are applying? yes no If yes, please explain
REFERENCES
(Please list three persons not related to you, whom you have known at least one year
Name, Address (street, city, state, zip code) Phone, Position
List any additional information regarding your knowledge, skills and experience relative to the job for which you are applying.
I hereby certify that the above information to the best of my knowledge is true, accurate, and complete. Any misrepresentation or willful omissions of facts shall be sufficient cause for disqualification of this application or termination of employment. Furthermore, it is understood that this application and records become the property of the USD 112 which reserves the right to accept or reject it. I further agree to observe all rules, regulations, and policies of the USD 112 now in force and effect or as they may change during my employment, if I am employed by the District.
Signature of Applicant
I hereby authorize the USD 112 to conduct work history, personal reference or police record inquiries to determine my acceptability for employment.
Signature of Applicant

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USD 112 CENTRAL PLAINS

EMPLOYMENT APPLICATION NON-CERTIFIED PERSONNEL

EDUCATION

WORK EXPERIENCE

USD 112 CENTRAL PLAINS

REFERENCES