Support Staff Application
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First and Last Name *
Position Applying for (check all that apply) *
Required
Complete address *
Phone Number *
Social Security Number *
High School attended, Address, Dates attended *
College attended, Address, Dates attended, Highest degree obtained *
Do you have 60 college credit hours? *
Place of Employment and Address (Start with your present or last job) *
Dates of Employment *
Position held and Salary *
Supervisor's Name and Phone Number *
#2. Place of Employment and Address
#2. Dates of Employment
#2. Position held and Salary
#2. Supervisor's Name and Phone Number
#3. Place of Employment and Address
#3. Dates of Employment
#3. Position held and Salary
#3. Supervisor's Name and Phone Number
#1 Reference Name, Address, Phone Number, Relationship *
#2 Reference Name, Address, Phone Number, Relationship *
#3 Reference Name, Address, Phone Number, Relationship *
Students, their parents, and employees of the Westran R-I School District are hereby notified that this school district does not discriminate on the basis of sex or handicap as required by Title VI of the Civil Rights Act of 1964; and Title IX of the EducationAmendments Act of 1972. Equally, the Westran R-I School District does not discriminate on the basis of race, color, national origin, sex or handicap in its educational activities and employment practices according to Section 504 of the Rehabilitation Act of 1973. Any person having inquiries concerning the Westran R-I School District Compliance with Title VI, Title IX, or Section 504 is directed to contact the Superintendent of Schools, Westran R-I School District, 228 Huntsville Ave., Huntsville, Missouri 65259, office phone 1-660-277-4429. The Superintendent has been designated by the Westran R-I School District to coordinate the school district’s efforts to comply with Title VI, Title IX, and Section 504. *
Signature and Date *
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