APPLICATION FOR EMPLOYMENT

Transcription

1 CHATFIELD PUBLIC SCHOOLS 205 UNION STREET N.E. CHATFIELD, MN APPLICATION FOR EMPLOYMENT Chatfield Public Schools is an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on the basis of race, color, creed, religion, national origin, age, sex, disability, marital status, or status with regard to public assistance. ============================================================= NAME PHONE NO.( ) Last First Middle Initial PRESENT ADDRESS Street City/State/Zip Code PERMANENT ADDRESS Street City/State/Zip Code Date available for work Part Time Full Time Position Desired If you are claiming veteran s preference, please complete the following: MILITARY SERVICE: Are you a Veteran? Yes No Branch of Service Type of Discharge EDUCATION NAME AND LOCATION DEGREE/COURSE OF STUDY High School College Graduate School Trade, Business or Other School Subjects of Special Study or Research Work *If hired a Criminal Background Check will be conducted-m.s , SEC.2

2 EMPLOYMENT HISTORY Starting with your present or most recent employer, please list your last four jobs. Do not omit any work experience Special skills/qualifications you possess which are directly related to the position for which you are applying. Clerical Typing wpm Machines/Equipment Other Are you employed now? Yes No May we contact your present employer? Yes No May we contact your past employers? Yes No Comments References-List three persons not related to you who have known you for at least a year, preferably job related. I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for refusal of employment or dismissal. I also understand that my employment is subject to the policies and procedures of the Chosen Valley Public Schools. Applicant Signature Date

3 RELEASE AUTHORIZATION I hereby authorize (previous employer) to release information from my personnel file regarding my employment with that company to the Chatfield Public Schools for purposes of providing supplementary information to the application for employment I have placed with Chatfield Public Schools. Dates of employment with this company: to Date: Signature: REQUEST FOR INFORMATION PAST EMPLOYER RESPONSE The above named employee was employed with this company during the following dates: From to Reason employee left your employment? Is the employee eligible for rehire? Personal appearance/presentation Excellent Good Fair Poor Comments Competence for position Common sense/maturity Cooperation with co workers, supervisors Attitude and enthusiasm Initiative and resourcefulness Ability to work independently Accuracy in skills Attendance Comments: Date: By:

4 AFFIRMATIVE ACTION SURVEY Applicants are considered for all positions, and employees are treated without regard to race, color, creed, religion, national origin, sex, disability, age, marital status, or status with regard to public assistance. As an employer, we comply with government regulations and affirmative action responsibilities. To assist us with government record keeping, reporting and other legal requirements, we ask that you fill out this survey. Providing this information is voluntary, and the information you provide will be kept confidential and in a file separate from your application. Thank you. PLEASE PRINT Name Phone No.( ) Addresss Street City State Zip Position applied for Date Applied Check one: Male Female Race/Ethnic Group check one of the following: Caucasian: (Not Hispanic origin), includes persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. Black: (Not Hispanic origin), includes persons having origins in any of the Black African racial groups. Hispanic: Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other culture or origin, regardless of race. American Indian/Alaskan Native: Persons having origins in any of the original peoples of North America, and who maintain identifiable tribal affiliation through Membership and participation or community recognition. Asian/Pacific Islander: Persons having origins in any of the original people of the Far East, Southeast, Asia, the Indian Subcontinent, or the Pacific Islands. This area Includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa. Check if any of the following are applicable: Vietnam Era Veteran Disabled Veteran Handicapped Individual How did you learn about this position? Posted job announcement at this office Friend or relative State Employment Office (Job Service) Private Employment Agency Rehire Want Ad-Rochester Newspaper Want Ad-Other Minnesota Newspaper Want Ad-Newspaper from another state Walk-in Other (explain)

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