PULLMAN SCHOOL DISTRICT NO. 267

240 SE Dexter Street • Pullman, WA 99163

Personnel Office (509) 332-3584 • FAX (509) 334-0375

Website:

APPLICATION FOR COACH/STUDENT ADVISOR

DATE:

POSITION FOR WHICH YOU ARE APPLYING:

PERSONAL INFORMATION

Name: Last / First / MI
Other Names Used / Social Security No.
Temporary Address / City / State / Zip
Permanent Address / City / State / Zip
Telephone (local) / Message Number / Email
Do you have a current First Aid Card?
 Yes  No Expiration Date: / Do you have a current CPR Card?
 Yes  No Expiration Date:
Dates / times available for work:

IN CASE OF EMERGENCY PLEASE NOTIFY

Name / Telephone
Address / City / State / Zip

EDUCATION AND TRAINING (list most recent first)

Name of School
City, State / Dates Attended
Mo/Yr to Mo/Yr / Year Completed / Degree / Date of Degree

EMPLOYMENT EXPERIENCE (list most recent experience first)

Employer / Address
City , State Zip / Dates
Mo/Yr to Mo/Yr / Position Title/Duties / Reason for Leaving

COACHING EXPERIENCE(list most recent experience first, include volunteer experience)

Employer / Address
City , State Zip / Dates
Mo/Yr to Mo/Yr / Position Title/Duties / Reason for Leaving

REFERENCES(Professional only – do not list friends or relatives)

Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:
Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:
Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:
Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:

• I hereby authorize the Pullman School District to make any investigation of my personal or employmenthistory and authorize any former employer, person or organization to give Pullman School District any information regarding me. I release the PullmanSchool District, its employees and/or agents and all providers of information from any liability as a result of furnishing and receiving this information.

• 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.

Signature Date

PULLMANSCHOOL DISTRICT MAINTAINS A TOBACCO FREE AND DRUG FREE ENVIRONMENT

PULLMAN SCHOOL DISTRICT IS AN EQUAL OPPORTUNITY EMPLOYER

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, . Applicants with disabilities may request reasonable accommodations in the application process by contacting the Human Resources Manager at (509) 332-3584.