USD 243 Lebo-Waverly                                  
CLASSIFIED STAFF EMPLOYMENT APPLICATION

NOTICE TO APPLICANT:
It is the policy of the Board of Education of Unified School District #243, Lebo-Waverly, Kansas, to assure equal opportunity to qualified individuals regardless of their race, religion, color, sex, national origin, ancestry, or age, and to promote the full realization of equal opportunities to everyone.

This policy covers all aspects of the employment relationships including recruitment, hiring, placement, promotion, transfer, training, and apprenticeship, compensation, layoff, termination, and harassment.

If you have any questions regarding the above, contact the district's Title IX Coordinator and Section 504 Coordinator:      

Corey Reese, Superintendent
411 Pearson
Waverly, kansas 66871

APPLICATIONS MUST BE RENEWED YEARLY.  APPLICATIONS ARE RETAINED FOR ONE YEAR FROM THE DATE OF INITIAL APPLICATION

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Email *
Last Name *
First Name *
Middle Initial or Name
Street Address *
City *
State & Zip Code *
Phone Number *
List any other name(s) you may have been known by which would be required to verify any information contained in this application.
Position Applying for *
Required
Have you ever been dismissed or asked to resign from employment?  If yes, please explain.
Have you ever been convicted  of the following (check if the answer is yes). If you answer yes to either of these, please explain in the next option.
If you answered  "YES" to any of the options in the above question, please explain including  the nature of the crime(s), when and where convicted and disposition of the case..
Education: High School Attended and Location
Education: College Attended and Location
Education: OTHER
Work Experience (1) Please include Name of Firm or Organization, Contact information, Supervisor's Name, Dates employed, Reason for leaving.
Work Experience (2) Please include Name of Firm or Organization, Contact information, Supervisor's Name, Dates employed, Reason for leaving.
Work Experience (3) Please include Name of Firm or Organization, Contact information, Supervisor's Name, Dates employed, Reason for leaving.
Work Experience (4) Please include Name of Firm or Organization, Contact information, Supervisor's Name, Dates employed, Reason for leaving.
References (1) List persons who know your abilities and   general ;abilities.  This person may be contacted by telephone or written correspondence.  Include NAME, PHONE, AND ADDRESS.   *
References (2) List persons who know your abilities and   general ;abilities.  This person may be contacted by telephone or written correspondence.  Include NAME, PHONE, AND ADDRESS.   *
References (3) List persons who know your abilities and   general ;abilities.  This person may be contacted by telephone or written correspondence.  Include NAME, PHONE, AND ADDRESS.   *
AGREEMENT
I certify that all the information provided by me in this application is true and complete. I understand that any misstatement, falsification, or omission of information is grounds for refusal to hire or, if I'm hired  and the same is discoved thereafter, termination.  

I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education,, or any other information, personal or otherwise, with regard to any of the subjects covered by tis application, and I release all such parties from all liability for any damages that may result from furnishing such information to you.  I authorize any background checks by any third part.

I authorize. you to request, receive, and verify all information given on thes application and I release you from all damages that may result from you doing so.

I authorize you to conduct a criminal background investigation using andy and all methods necessary to successfully complete such investigation, and I release you from all liability for any damages that may result from your doing so.

I understand that if I am offered provisional employment in the school district, that my fingerprints may be taken, and a request made for a state and national criminal background check,  I further understand that if the results of this criminal history check reveal that I have been convicted of any offense or any attempt to commit any offense specified in K.S.A 1999 Supp. 72-1397, and amendments thereto, that my employment may be terminated.

As an digital signature, please list your date of birth and the where you were born. *
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