208 South Street District Administration Center Lake Geneva, WI Phone: (262) FAX: (262)

Transcription

1 LAKE GENEVA SCHOOLS 208 South Street District Administration Center Lake Geneva, WI Phone: (262) FAX: (262) I. PERSONAL DATA SUPPORT STAFF APPLICATION (All Non-teaching Staff) Name Address Last First Middle Present Address Street City State Zip Telephone: Work Home Cell Position applying for: available for employment: Have you previously applied for a position with the district? Yes No If so, give date: Which position? II: REFERENCES Include references from your last three positions. Additional references may be required or provided. Full Name Address Phone Position

2 Page 2 III. EDUCATION AND TRAINING High School Name Location From/To Post high school education (most recent first) Name/Location of School s Attended From/To Degree Major/Minor Use this space to further describe your education and training as it relates to the position for which you are applying. IV. PREVIOUS WORK EXPERIENCE From/To Position Employer/Location Supervisor Phone Why do you desire to leave your present position, or why did you leave your last position?

3 Page 3 Are you aware of any reason you would not be able to perform the duties required of the position for which you are applying? Yes No V. PERSONAL STATEMENT In the space provided, prepare a hand written statement to support your application for this position. You may include additional information pertaining to items on your application form. You may also use this space to explain why you think you are the person to hire for this position. List the subjects taken which relate to the position for which you are applying. Use this space to further describe your education and training as it relates to the position for which you are applying. Use this space to further explain your work experience as it relates to the position for which you are applying. Indicate any skills, experiences, or training (military, on the job, or other) you have received.

4 Page 4 VI. BACKGROUND INFORMATION (Please Check One) 1. Are you a former or current employee of the district? Yes No 2. Are you a U.S. citizen? Yes No If no, are you eligible to work in the U.S.? Yes No 3. Have you ever been convicted of a felony, misdemeanor, or other offense (other than minor traffic violations), or do you have such a charge pending? Yes No NOTE: (If you answered yes, please attach a document, which will be incorporated into this application that describes the facts of such a conviction/charge.) Convictions or pending charges are not an automatic bar to employment, but are reviewed in relation to the job for which you applied. Failure to report all convictions and/or pending charges as specified on this application may result in rejection of your application or discharge from employment. 4. Have you ever been dismissed or asked to resign from any position? Yes No 5. Are you currently employed and/or under contract? Yes No If yes, state length of notice required to terminate current position. 6. Have you ever had a professional license revoked or suspended? Yes No 7. Is revocation or suspension of a professional license pending? Yes No This application will be kept on file for one year from the date of application. It must be renewed if further consideration for a position is desired.

5 LAKE GENEVA SCHOOLS Page 5 AUTHORIZATION FOR RELEASE OF INFORMATION AND AFFIRMATION OF ACCURACY OF APPLICATION Please read carefully before signing this form. MY SIGNATURE BELOW CERTIFIES that the above information and attachments are true and accurate to the best of my knowledge. If employed by this school district, I understand that any misrepresentation of factual information contained herein may be cause for dismissal. MY SIGNATURE BELOW AUTHORIZES the Lake Geneva School District to process my application for employment by checking references with former employers, schools, colleges, individuals, and law enforcement agencies. MY SIGNATURE BELOW RELEASES the Lake Geneva School District, its employees and representatives, from all liability for any damage whatsoever incurred in obtaining information from references or in further disseminating such information. If you are recommended for employment, a criminal background check and physical entrance examination must be satisfactorily completed before you will be hired. PRINT NAME SIGNATURE DATE It is the policy of the Lake Geneva School District, pursuant to applicable State and Federal Law, along with exceptions and defenses as defined by law, that no person shall be subject to discrimination in employment on the basis of age; race; creed; color; sex; handicap; religion; national origin; sexual orientation; ancestry; pregnancy; marital or parental status; physical, mental, emotional or learning disability; arrest record; conviction record not substantially related to the job for which the individual is applying; membership in the national guard, state defense force, or any reserve component of the military forces of the United States of American and the State of Wisconsin; the use or non-use of lawful products off the employer s premises during nonworking hours; or any other reason prohibited by state or federal law. Rev: 4/2011 DO NOT WRITE IN THIS SPACE FOR OFFICE USE ONLY Contract issued for Position Title Assigned to School Location Effective date of employment (for seniority purposes) Replaces Interviewed by Supervisor Additional information Background check