Adopted: 05/19/2008

533.1

APPLICATION FOR PROFESSIONAL POSITION

All statements made by applicants for employment on this application form will be checked for accuracy.  We offer equal employment opportunities to all persons without regard to sex, race, national origin, religion, ancestry, creed, pregnancy, marital or parental status, sexual orientation, or physical, mental, emotional, or learning disability or handicap.

=============================================================== PERSONAL INFORMATION:

NAME:  ______________________________________________DATE:______

PRESENT ADDRESS:        ___________________________________________

                                                ___________________________________________

PERMANENT ADDRESS:  ___________________________________________

                                                ___________________________________________

PRESENT TELEPHONE:               _____________________________________

PERMANENT TELEPHONE:         _____________________________________

(if different from above)

SOCIAL SECURITY #:                     _____________________________________

Do you hold a valid Wisconsin Teacher's Certificate for the subject or position for which you have applied?                        _____Yes                  _____NO

If the answer is no, please explain:_____________________________________

________________________________________________________________________________________________________________________________

Give certificate information below:

Subject, Grade or Position                                                         Certification Expiration

you are certified for:              Major(s)          Minor(s)          Number          Date

________________________________________________________________

________________________________________________________________

________________________________________________________________

List the student activities you feel you could work with:  (i.e., coaching, drama, speech, newspaper, cheerleading, etc.)

________________________________________________________________

________________________________________________________________

Are you a certified coach?               _____Yes                  _____No

What sport/s?_____________________________________________________

EDUCATION TRAINING:

                                                                                                                             Date of     

Attended                    Dates                          Name of School        Degree  Graduation

=============================================================

High School               ________________________________________________

College/University     ________________________________________________

                                    ________________________________________________

Graduate School       ________________________________________________

                                    ________________________________________________

Other                           ________________________________________________

STUDENT TEACHING:       (Persons with more than two years of teaching experience need not complete this portion.)

Name of School/City           Critic Teacher     Subject        Dates   Weeks   Hours

                                                                             or Grade

=============================================================

________________________________________________________________

________________________________________________________________

________________________________________________________________

EXPERIENCE:                      (Present employer first)

=============================================================

                                                            Position:                                 Salary:__________

Name:                                                 From:________________________________

Address:                                            To:__________________________________

Supervisor:                                        Reason for leaving:_____________________

Telephone:_______________________________________________________

                                                            Position:                                 Salary:__________

Name:                                                 From:________________________________

Address:                                            To:__________________________________

Supervisor:                                        Reason for leaving:_____________________

Telephone:_______________________________________________________

                                                            Position:                                 Salary:__________

Name:                                                 From:________________________________

Address:                                            To:__________________________________

Supervisor:                                        Reason for leaving:_____________________

Telephone:_______________________________________________________

REFERENCES:

Name                                      Position                      Address                     Phone #

=============================================================________________________________________________________________________________________________________________________________________________________________________________________________

PROFESSIONAL ORGANIZATIONS:

List the professional organizations to which you belong, include any position you may hold within those organizations:

=============================================================

________________________________________________________________________________________________________________________________________________________________________________________________

COMMUNITY ACTIVITIES & ORGANIZATIONS:

List any community activities and organizations you have participated in during the past three years.

=============================================================

________________________________________________________________________________________________________________________________________________________________________________________________

PERSONAL STATEMENT:

Prepare a personal statement to include any experience or talent which in your estimation will contribute to your success in the position for which you are making application.

=============================================================

________________________________________________________________________________________________________________________________________________________________________________________________

The applicant is free to attach any supporting documentation that can enhance their candidacy.

PLEASE ANSWER THE FOLLOWING QUESTIONS:

1)         Do you have the legal right to work in the United States?

            _____Yes                  _____No

            If not, why?___________________________________________________________

            __________________________________________________________

2)         Have you ever been convicted of a crime except a minor traffic violation?

            _____Yes                  _____No

            If so, state citation, date, court, and place where offense occurred.______

            __________________________________________________________

3)         Have you ever been discharged or requested to resign from a position?

            _____Yes                  _____No

            __________________________________________________________

4)         Have you applied for a job with us before?

            _____Yes                  _____No

            What job?___________________________________________________

5)         Are you now employed?

            _____Yes                  _____No

JOB APPLICANT AGREEMENT AND CERTIFICATION:

I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge.  I authorize the use of any information in this application to verify my statements, and I authorize the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.  I release all such persons from any liability or damages on account of having furnished such information.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between this employer and myself for either employment or for the providing of any benefit.  No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the employer unless in writing.

I understand that prior to being offered employment I may be requested to take an employment examination.  In the event I have a disability which will affect my ability to take the test, I will so inform the employer prior to the administration of the test so that a reasonable accommodation can be made.  Requested accommodations may include accessible testing sites, modified testing conditions, and accessible testing formats.  The employer reserves the right to require medical documentation concerning the need for the accommodation.

I understand that if I am recommended for employment, the employer may run a criminal background check and that a physical entrance examination must be satisfactorily completed that may include drug testing.

I understand that if employed, policies and rules which are issued are not conditions of employment and that the employer may revise policies or procedures, in  whole or in part, at any time.

I understand that this application will be kept on active file for thirty days from the date completed, after which time I would have to reapply in accordance with established district procedures.

_______________________________________________  ________________

Signature of Applicant                                                                      Date