<p> PULLMAN SCHOOL DISTRICT NO. 267 240 SE Dexter Street • Pullman, WA 99163 Personnel Office (509) 332-3584 • FAX (509) 334-0375 Website: www.psd267.wednet.edu</p><p>APPLICATION FOR COACH/STUDENT ADVISOR</p><p>Thank you for applying for a position in the Pullman School District. To be considered for an interview, please submit the following:</p><p> Pullman School District Application PLEASE COMPLETE ALL SECTIONS ON THE APPLICATION FORM.  Applicant Disclosure Statement  Formal typed letter of application addressing qualifications  Current resume  Copy of applicable licenses or certificates  One or more letter(s) of recommendation (can be sent directly to the Pullman School District)  Affirmative Action form (completion is voluntary).</p><p>DATE: </p><p>POSITION FOR WHICH YOU ARE APPLYING:</p><p>PERSONAL INFORMATION</p><p>Name: Last First MI</p><p>Other Names Used Social Security No. </p><p>Temporary Address City State Zip </p><p>Permanent Address City State Zip </p><p>Telephone (local) Message Number Email</p><p>Do you have a current First Aid Card? Do you have a current CPR Card? </p><p> Yes  No Expiration Date:  Yes  No Expiration Date: </p><p>Dates / times available for work: </p><p>IN CASE OF EMERGENCY PLEASE NOTIFY</p><p>Name Telephone</p><p>Address City State Zip EDUCATION AND TRAINING (list most recent first)</p><p>Name of School Dates Attended Year Degree Date of City, State Mo/Yr to Mo/Yr Completed Degree</p><p>EMPLOYMENT EXPERIENCE (list most recent experience first) </p><p>Employer Address Dates Position Title/Duties Reason for City , State Zip Mo/Yr to Mo/Yr Leaving</p><p>COACHING EXPERIENCE (list most recent experience first, include volunteer experience) </p><p>Employer Address Dates Position Title/Duties Reason for City , State Zip Mo/Yr to Mo/Yr Leaving REFERENCES (Professional only – do not list friends or relatives)</p><p>Name Position / Relationship </p><p>Address , City, State Zip Telephone Home: Business: </p><p>Name Position / Relationship </p><p>Address , City, State Zip Telephone Home: Business: </p><p>Name Position / Relationship </p><p>Address , City, State Zip Telephone Home: Business: </p><p>Name Position / Relationship </p><p>Address , City, State Zip Telephone Home: Business: </p><p>• I hereby authorize the Pullman School District to make any investigation of my personal or employment history and authorize any former employer, person or organization to give Pullman School District any information regarding me. I release the Pullman School District, its employees and/or agents and all providers of information from any liability as a result of furnishing and receiving this information. </p><p>• I certify that the information presented in this application is true and complete to the best of my knowledge and I have read and understand that I have authorized the district to conduct reference checks. I further agree that if I am employed, I will provide verification of my certification, education and experience. I understand if I am employed, false statements on this application may be cause for dismissal. </p><p>Signature Date </p><p>PULLMAN SCHOOL DISTRICT MAINTAINS A TOBACCO FREE AND DRUG FREE ENVIRONMENT</p><p>PULLMAN SCHOOL DISTRICT IS AN EQUAL OPPORTUNITY EMPLOYER</p><p>The Pullman School District does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth groups. The following employee has been designated to handle questions and complaints of alleged discrimination: Assistant Superintendent, Pullman School District Administrative Offices, 240 SE Dexter Street, Pullman, WA 99163, (509) 332-3144, [email protected]. Applicants with disabilities may request reasonable accommodations in the application process by contacting the Human Resources Manager at (509) 332-3584.</p>