Mount Adams School District No

APPLICATION FOR CLASSIFIED EMPLOYMENT NAME: POSITION DESIRED:

Mount Adams School District No. 209 PO Box 578 – White Swan, WA 98952 – (509)874-2611 – Fax (509)874-2960

We have a detailed and comprehensive staff selection system and ask that you provide all information requested in this form. If it is necessary for you to leave a space blank, please put “Not Appropriate”, “None”, or other comment indicating that you consciously left that space blank instead of overlooking or ignoring it. Please type or print. WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Position(s) Applied For Date of Application

Last Name First Name Middle Name

Address Phone #

City, State Zip SSN

If you are under 18 years of age, can you provide required proof __ YES __ NO of your eligibility to work? Have you ever filled out an application with us before? __ YES __ NO Have you every been employed with us before? __ YES __ NO If yes, give date: ______Are you currently employed? __ YES __ NO May we contact your current employer? __ YES __ NO On what date would you be available for work? ______Full Time __ Part Time Are you available to work: __ Shift Work __ Temporary

Name/Address of Years EDUCATION Course of Study Diploma/Degree School Completed Elementary School

High School

College

REFERENCES Name Phone # 1. ( ) 2. ( ) 3. ( ) APPLICATION FOR CLASSIFIED EMPLOYMENT NAME: POSITION DESIRED:

EMPLOYMENT EXPERIENCE: Start with your present or last job. You may include any job- related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

1 Employer From To Work Performed

Address

Telephone Number(s) Hourly Rate/Salary

Job Title Supervisor Starting Final

Reason for leaving

Address

Reason for leaving

Address

Reason for leaving

Address

Reason for leaving APPLICATION FOR CLASSIFIED EMPLOYMENT NAME: POSITION DESIRED:

FOOD SERVICE/TRANSPORTATION/CUSTODIAN/MAINTENANCE/ GROUNDS/TEACHER AIDE/OFFICE WORKER/COACHING

FOOD SERVICE Have you worked in food service in another school district? ______restaurant? ______other? ______Check those that you have experience in: __ Cooking __ Kitchen Work __ Buying __ Menu Planning __ Dish Washing __ Clean Up

TRANSPORTATION/MECHANIC Valid WA State Driver’s License #: ______Expires: ______School Bus Driver’s Certificate #: ______Expires: ______Have you been convicted or forfeited bail of a traffic violation in the past five years? __ Yes __ No If yes, please explain ______Has your privilege to drive a motor vehicle ever been suspended , revoked or denied? __ Yes __ No If yes, please explain ______Have you been employed as a Mechanic? __ Yes __ No If yes, what types of vehicles? ______Have you driven buses and/or trucks? __ Yes __ No

CUSTODIAN, MAINTENANCE AND GROUNDS Describe relevant duties you have performed: ______Skills: __ Carpenter __ Electrician __ Mason __ Painter __ Plumber __ Boiler Operated: __ Trucks __ Tractors __ Bulldozers __ Lawn Mowers __ Other Have you operated custodial equipment, such as buffers, extractors, power washers…? ______Have you used cleaning chemicals? ______

TEACHER AIDE/OFFICE WORKER Office Skills: __ Typing (WPM: ___) __ Phone __ Receptionist __ Computer __ Ten-key __ Accounting __ Other Office Machines: ______Office Experience: ______Teacher Aide Experience: ______School District Experience: ______

COACHING EXPERIENCE ______

List professional, trade, business or civic activities and offices held. (You may exclude membership which would reveal gender, race, religion, national origin, age, disability or other protected status.) APPLICATION FOR CLASSIFIED EMPLOYMENT NAME: POSITION DESIRED:

State any additional information you feel may be helpful to us in considering your application.

Describe any specialized training, apprenticeship, skills and extra-curricular activities. Summarize special job-related skills and qualifications acquired from employment or other experience.

Describe the experiences you have had in the supervision of and direction of children and youth.

PLEASE NOTE: Applicant agrees to the following conditions of employment: Any material misrepresentation or deliberate omission of a fact in my application may be justification for refund of, or if employed, termination from employment.

It is my understanding that the district will make an investigation of my work and personal history and may verify all data given in my application for employment, related papers, or check interviews. I authorize such an investigation.

Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

I further understand that this is an application for employment and not a contract of employment.

I understand that if I am employed, such employment is for an indefinite period of time and that the school district can change wages, benefits, and conditions at any time.

A finger print check and/or pre-employment drug screening may be required and an inquiry to the Washington State Patrol and/or state and federal law enforcement agency may be made.

I hereby certify that all statements in the employment application which includes inserts and attachments are true and complete. I understand that if employed, falsified statements on the application shall be considered sufficient cause for dismissal.

Signature of Applicant Date EMPLOYMENT DATA RECORD: Government agencies at times require periodic reports on various background traits of employees. This data is for statistical analysis with respect to the success of the Affirmative Action program. SUBMISSION OF THIS INFORMATION IS VOLUNTARY. Inclusion or exclusion of any data will not affect any employment decision. Current Job: ______Male __ Female Birth Date: ______Check one: __ White __ Hispanic __ American Indian, Alaskan Native __ Black __ Other Check in applicable: __ Disabled Veteran __ Vietnam Era Veteran __ Handicapped