Goodman-Armstrong Creek School District

GOODMAN-ARMSTRONG CREEK SCHOOL DISTRICT APPLICATION FOR EMPLOYMENT

It is the policy of this school district to provide equal employment opportunities to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, physical or mental handicap or veteran status.

Note: Please type or print your answers. If you print, please do so in blue or black ink and write neatly. An illegible application may preclude you from consideration.

PERSONAL INFORMATION ______First Name Middle Initial Last Name

Current Address: ______Street and Apt. # City State Zip Code

Permanent Address (if different from above): ______Street and Apt. # City State Zip Code

Telephone:______E-mail:______

Social Security #______Driver’s License #______

I am a U.S. Citizen or otherwise authorized to work in the United States on an unrestricted basis: Yes______No______

If applicable, please list your visa type, visa # and expiration: ______

Have you ever been convicted of a crime in the past seven years (you are not obligated to disclose sealed or expunged criminal records)? ____Yes ____No ______

Have you ever served in the U.S. Military? ____Yes ____No If yes, please provide the following information: Branch of Service: ______Rank at time of separation:______I served from ______to ______

Special Honors: ______Last Name:______First Name:______Middle Initial:______

EMPLOYMENT HISTORY:

Present or Most Recent Employer

Employer:______Address:______Your Position:______Salary:______Duties:______Dates of Employment:______to ______Supervisor:______May we contact? ____Yes ____No Name Title

Reason(s) for Leaving:______

Prior Employer

Reason(s) for Leaving:______

Prior Employer

Reason(s) for Leaving:______Last Name:______First Name:______Middle Initial:______

EDUCATION

High School ______Name and Address

Did you graduate? ____Yes ____No Attended from ______to ______

If you did not graduate, did you receive your GED? ____Yes ____No

Special honors or awards: ______

Technical or Vocational School ______Name and Address

College or University ______Name and Address

Special honors or awards: ______Last Name:______First Name:______Middle Initial:_____

POSITION INFORMATION:

Position Specifications

Position applying for: ______How did you hear about this job? ______What hours are you willing to work? ______

Would you be able to work weekends? ____Yes ____No Are you willing to travel for the job? ____Yes ____No When would you be able to start? ______Desired salary: ______per ______

Skills

Please describe any skills you have in the following areas:

Computer: ______

Languages spoken (other than English): ______

Other: ______

I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this school district to investigate any aspect of my prior educational and employment history.

Furthermore, I understand that if I am hired, employment with this school district is “at will,” which means that either the district or I can terminate my employment for any reason not prohibited by state or federal law.

Signature: ______Date:______GOODMAN-ARMSTRONG CREEK SCHOOL DISTRICT **************************************************************************

We request your permission to do a background check consisting of a criminal history and driver record check. (Reference: Wisconsin Statue 111.335)

Today’s Date: ______

First Name: ______Middle Name: ______

Last Name: ______

List Any Other Name(s) Used: ______

Current Address: ______

Telephone Number: ______

Date of Birth: ______Social Security Number: ______

Driver’s License Number: ______

By signing this form, you give the Goodman-Armstrong Creek School District permission to obtain a criminal history and driver record check.

Signature: ______