APPLICATION FOR CLASSIFIED POSITION
Harmony Grove School District
401 Ouachita Road 88
Camden, Arkansas 71701
APPLICANT INFORMATION
Name
First Name
Middle Initial
Last Name
Date:
-
Month
-
Day
Year
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Format: (000) 000-0000.
Social Security Number:
Are you a U.S. Citizen?
If no, explain status:
Have you ever been convicted of a felony (including any expunged sexual offenses)?
Is your name on the Child Maltreatment Central Registry?
Do you have any impairment that would interfere with your performance for the job you are applying for?
Have you previously been employed by Harmony Grove School District?
If "yes", when:
Date you expect to be available for employment:
-
Month
-
Day
Year
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How long should the application remain active?
Please check position desired:
Secretary
Custodian
Maintenance
Bus Driver
Cafeteria
Nurse
GENERAL FACTS
What qualifications, experience, skills, or training do you have that would equip you for the position you desire?
Have you ever been released or requested to resign, from a place of employment?
If "yes", please explain:
Why do you wish to leave your present position?
Why do you wish to work at Harmony Grove School District?
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EDUCATION
Rows
School Attended
Dates From/To
Major/Minor
Degree
Date of Graduation (MM/YYYY)
High School
College
College
WORK EXPERIENCE
Rows
Employer
Types of Work
Date of Employment
1
2
3
4
5
REFERENCES
Rows
Name of Reference
Address
Phone
1
2
3
4
5
I hereby release the officers, agents, employees, and directors of each of my past employers from any and all liability arising from disclosure of personal records and from verbal appraisals of my past performance made to the superintendent and board members of the Harmony Grove School District. I understand and agree that this waiver includes any and all manners of action that I may not have or may have in the future concerning such disclosures, regardless of their nature.
I certify that the information presented in this application is true. I understand that falsifying any information on this application is grounds for dismissal should I be employed by the Harmony Grove School District.
Applicant Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
HARMONY GROVE IS AN EQUAL OPPORTUNITY EMPLOYER
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