USD 216 Classified Application for Employment

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PERSONAL INFORMATION

Name *

Please provide your first, middle and last name

Date *

YYYY

Present Address (Street, City, State, Zip Code) *

Email *

Phone number *

Are you 18 years of age or older? *

Yes

Are you prevented from lawfully becoming employed in this country because of visa or immigration status? *

Yes

EMPLOYMENT DESIRED

Which position(s) are you interested in? *

If you selected "Coaching/Sponsor" please indicate what sports you would be interested in coaching, or what activities or classes you would like to sponsor.

Date you can start: *

YYYY

Salary Desired:

Are you currently employed? *

Yes

If so may we inquire of your present employer?
*

Yes

Have you ever applied to this company before? *

Yes

If so, when did you apply?

YYYY

Referred by: *

EDUCATIONAL HISTORY

Please list the name and location of the High School you attended: *

Did you graduate? *

Yes

Please list the name and location of the Post Secondary School you attended:
*

Did you graduate? *

Yes

Please list the name and location of the any Trade, Business or Correspondence Schools you attended:

Did you graduate?

Yes

Clear selection

EMPLOYMENT HISTORY

Please list the name and address of your most recent employer: *

Please list the position held, and your reason for leaving: *

Length of time employed: *

Please list the name and address of your previous employer: *

Please list the position held, and your reason for leaving: *

Length of time employed: *

Please list the name and address of your previous employer: *

Please list the position held, and your reason for leaving: *

Length of time employed: *

REFERENCES

Please list the name, occupation, address, phone number, and relationship of three persons not related to you, whom you have known for at least one year.

Reference #1 *

Reference #2 *

Reference #3 *

Do you have any health conditions that would prevent you from performing any of the tasks required by this position? *

Yes

Maybe

If yes or maybe, please explain:

Have you ever been convicted of any felony involving another person, any crime involving a child, or any major traffic violations? *

Yes

By signing this application, I agree to allow Deerfield USD 216 to submit my name to the Kansas Bureau of Investigation for a criminal record, and to the Kansas Driver's Licensing and Control, Topeka Kansas for a driving record.

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered my application may be rejected. *

Yes

Required

AN EQUAL EMPLOYMENT/EDUCATION OPPORTUNITY AGENCY

Unified School District #216 does not discriminate on the basis of race, color, national origin, sex, age, or disability in admission or access to, or treatment or employment in, its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. Any person having inquiries concerning Unified School District #216 compliance with the regulations implementing Title VI, ADA, Title IX, or Section 504 is directed to contact the Unified School District #216, Superintendent of Schools, tyson.eslinger@usd216.org, 803 Beech St., Deerfield, Kansas 67846, 620-426-8516.

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