APPLICATION FOR EMPLOYMENT
Fairfield U.S.D. #310
16115 South Langdon Road
Langdon, Kansas 67583
(620) 596-2152
Date______
Please indicate the area(s) of employment you are applying for: Type of Employment:
Office Transportation Full Time
Food Service Teacher’s Aide Part Time
Custodial Other (list) Substitute
1. PERSONAL DATA
Name: Soc. Sec. #
Address:
(Mailing and Street) (City) (Zip)
Home Telephone:______(Alt. Number):______Work Phone:
2. EDUCATIONAL BACKGROUND
Elementary School (last attended)______
High School (last attended)______Year Graduated______
College or University______
3. WORK EXPERIENCE (List most recent employment first).
Employer/Address Position Dates Employed Reason for Leaving
4. REFERENCES (Example: neighbor, friend, minister, former employer, etc.).
Name Address Telephone Number
Please complete front and back of this application and return to the address given above! Thank You!
5. OFFICE APPLICANTS - Please list skills as keyboarding, computer program knowledge, and etc.
6. CUSTODIAL APPLICANTS – Check any of the following areas that you have experience in.
Carpenter work Plumbing work Floor maintenance
Electrical work Painting (interior) Driver’s License
Yard work Painting (exterior) C D L license
7. BUS DRIVER APPLICANTS - Must be willing to submit to drug and alcohol tests.
List dates of: Defensive Driving , First Aid
Driver’s License Number Type Endorsements
You should be aware that your driving record will be checked.
8. LIST OTHER EXPERIENCES, SKILLS, ETC. which qualify you for work in U.S.D #310.
9. ASSIGNMENT LIMITATIONS/INTEREST (List any conditions to observe in making work assignments
Have you ever been convicted of a felony or crimes involving moral turpitude? Yes No
If yes, please explain. ______
Can you perform the tasks of the job for which you are applying? Yes No (If no, please explain) ______
Half day work only – (if so, state which half) ______
Limit to certain grade levels only (please list) ______
Other conditions ______
______
Please share with us why you are interested in this position______
______
I hereby certify that the above information is true and complete to the best of my knowledge and understand that any deliberate omission or falsification of facts may be grounds for refusal of or dismissal from employment. I authorize U.S.D. #310 to verify all information contained in this application.
Signature
USD #310 is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, sex, age, or disability.