Non-Certified and Supplemental Application
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YOU MAY PRINT THIS FORM AND ENTER THE INFORMATION USING A BLACK INK PEN.
YOU MUST SIGN THE LAST PAGE OF THIS FORM. YOU WILL NEED TO RETURN THIS FORM TO :
USD #247 SOUTHEAST
DISTRICT OFFICE
506 S. SMELTER
CHEROKEE, KANSAS 66724
NON-CERTIFIED PERSONNEL APPLICATION
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Name: _______________________________________________ |
Date: _______________ |
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Address: _________________________ City: ____________________ State: _____ Zip:__________ |
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Phone:______________________________ |
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Education: _____________________________________________________________________________
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POSITION BEING APPLIED FOR: __________________________________
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EXPERINCE: Employer Position Start/End Date Supervisor Reason for Leaving Salary
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If applying for bus driving position, please give driver license number and class of license:
Have you ever been convicted of a felony or Class A, B, or C misdemeanor in the state of Kansas or in any other state? Yes // No
WORK REFERENCES (person that can describe your job performance):
Name Address Phone Number
- _____________________________________________________________________
- _____________________________________________________________________
- _____________________________________________________________________
PERSONAL REFERENCES:
Name Address Phone Number
1. _____________________________________________________________________
2. _____________________________________________________________________
3._____________________________________________________________________
Give in your own words why you think you are qualified for this position. If extra space is needed, use reverse side of this form.
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If you want this application considered for a later opening, call 620-457-8350 when a vacancy occurs.
USD #247 Southeast, does not discriminate on the basis of race, color, national origin, sex, handicap, or age in admission or access to, or treatment or employment in, its programs or activities. Any questions regarding compliance with Title VI, Title IX or Section 504 may contact Dr. Glenn A Fortmayer (Title IX Coordinator or Section 504 Coordinator) at the above address.
APPLICANT JOB APPLICATION ACKNOWLEDGMENTS
1. I certify that all the information provided by me in this application is true and complete. I understand that any misstatement, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination.
2. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damages that may result from furnishing such information to you. I authorize any background checks by any third party.
3. I authorize you to request, receive, and verify all information given on this application and I release you from all damages that may result from your doing so.
4. I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete such investigation and I release you from all liability for any damages that may result from your doing so.
5. I attest that the information provided in this application is true and accurate to the fullest extent of my knowledge.
6. I understand omissions or inaccurate information on this application are grounds for termination for cause.
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Signature of Applicant Date
