Winnebago School District #323

Winchester CUSD #1 149 South Elm Street Winchester, IL 62694 (217)742-3175

Application for Employment – Non-Certified Staff

Position Applied for: Date:

Name (last, first, middle): Phone:

Present Address:

EDUCATION Schools Attended Name/Location Dates of Attendance Degree/Diploma High School College/University Other (specify)

EXPERIENCE List below all present and previous experience for the past five years, beginning with your most recent. Use the reverse side of this form if necessary. Location Dates Employed Reason for Employer City, State (From-To) Type of Work Leaving

REFERENCES Include persons under whom you are now working or have worked. Name Street Address, City, State Zip Phone

GENERAL INFORMATION List any skills and/or abilities you possess which would contribute to your effectiveness in the specific positions you have applied for (i.e. typing speed, computer skills, licenses held, or special training received).

THE FACTS SET FORTH ABOVE IN MY APPLICATION ARE TRUE AND COMPLETE Winchester CUSD #1 is an equal opportunity employer. Discrimination in employment practices on the basis of race, creed, color, sex, age, national origin, handicap or veteran status is prohibited.

Note: This application will be kept on file for six months. Should you wish toSignature of applicant Date be considered for employment after that time, please reapply.