Employment Application

Kalispell School District No. 5 and High School District

Human Resources

233 First Ave. East

Kalispell, MT 59901

406.751.3444

Kalispell School District is an equal opportunity employer. People of disability may request reasonable accommodation in the hiring process by contacting the Human Resources office.

Application Instructions

All sections of the application must be completed. Enter N/A into sections which are non-applicable. A job application with an original signature must be submitted for each position. Applications that are not signed will not be considered. Resumes will not be accepted in lieu of an application.

Job Information

Job Number: / Job Title:

PERSONAL INFORMATION

Name, Last: / First: / MI:
Address:
City: / State/Province: / Zip Code:
Contact Phone: / Email:
Yes / No
Are you 18 years of age or older? If not, please state age:
Are you a U.S. Citizen, permanent resident, or a foreign national with authorization to work in the United States?
Are you able with or without accommodation to perform the functions of this position?
Have you ever been convicted of, or entered a plea of guilty, no contest, had a withheld judgment to a felony, have criminal charges pending, or been dishonorably discharged from the U.S. Armed Services? If yes, please explain:
Conviction will not necessarily bar an applicant from employment.
Are you related to anyone who is a current District employee or a Board Trustee? If yes, please list name and job title:

EDUCATION

School / Name / Location / Major / No. of Credits / Graduated
Y or N / Degree Attained
High School
College
College
College
Vocational or Other
ADDITIONAL LICENSES OR CERTIFICATIONS / Yes / No
Are you applying for a job that requires a MT driver’s license?
If yes, license number and expiration date:
Are you a applying for a job that requires a MT commercial driver’s license? If yes, license number and expiration date:
Are you MHSA Coach Certified? If yes, expiration date:
Are you applying for a job that requires a State of Montana Educator License?
If you do not have a State of Montana Educator License, do you have the ability to attain one within 45 days of hire?
State of Montana Educator License holders complete below:
Folio #: Class: Level:
Expiration Date (XX/XX/XX) :
Endorsements:

ADDITIONAL SKILLS OR List any other experience, skills, licenses, or qualifications which you

QUALIFICATIONS believe are applicable.

Description:

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EMPLOYMENT HISTORY Begin with your most recent employment and continue with all past

employment. Attach additional pages if necessary.

Employer: / Start Date: / End Date:
Supervisor Name: / Contact Phone:
Address:
City: / State: / Zip Code:
Your Job Title: / Hours per Week:
Reason for Leaving:
Brief Work Description:

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Employer: / Start Date: / End Date:
Supervisor Name: / Contact Phone:
Address:
City: / State: / Zip Code:
Your Job Title: / Hours per Week:
Reason for Leaving:
Brief Work Description:

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Employer: / Start Date: / End Date:
Supervisor Name: / Contact Phone:
Address:
City: / State: / Zip Code:
Your Job Title: / Hours per Week:
Reason for Leaving:
Brief Work Description:

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Employer: / Start Date: / End Date:
Supervisor Name: / Contact Phone:
Address:
City: / State: / Zip Code:
Your Job Title: / Hours per Week:
Reason for Leaving:
Brief Work Description:

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Employer: / Start Date: / End Date:
Supervisor Name: / Contact Phone:
Address:
City: / State: / Zip Code:
Your Job Title: / Hours per Week:
Reason for Leaving:
Brief Work Description:

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PROFESSIONAL REFERENCES

Name: / Relationship:
Contact Number: / Email:
Name: / Relationship:
Contact Number: / Email:
Name: / Relationship:
Contact Number: / Email:

CONDITIONS

I understand and agree that I may be subject to immediate dismissal from employment if it shall be subsequently be determined or discovered that the answers herein and in any application supplements are untrue or that I have failed to disclose a material fact.
I authorized investigation of all statements and matters contained in this application that Kalispell School District No. 5 and High School District (District) may deem relevant to my employment, and I authorize all my previous employers or persons having information concerning me or my record to report such information to the District. I release each such person from all claims or liabilities whatsoever on account of making such inquiry or making such disclosures whether favorable or unfavorable.
I agree, if employed, to devote my best efforts to the performance of my duties, to comply with all rules and policies of the employer, and to obey all lawful directives of supervisors designated by the employer. It is understood and agreed that, in the event I am employed by District, a physical exam may be required and equal opportunity information may be requested. I understand that the District requires a drug, tobacco, and weapon free work sites and premises.
I have read and understand all portions of this application and supplements and have answered all questions completely and truthfully.

______

Signature of Applicant Date


AFFIRMATIVE ACTION FORM

Kalispell School District No. 5 and High School District

Title VII of the U.S. Civil Rights Act requires employers to "make and keep records relevant to the determinations of whether unlawful employment practices have been or are being committed". This is also a requirement of Montana Human Rights Act. The following survey helps fulfill these requirements.

This voluntary statement will be filed separately from all of your employment records. As require by State Law, it will be available only to the School District Human Resources Department and federal and state employment enforcement officers.

Please complete the following information and return it with our completed application.

Name:
Job Number: / Job Title:

Please select:MaleFemale

Race/Ethnicity:

(Please check one of the descriptions below corresponding to the ethnic group with which you most identify.)

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central

American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino) - A person having origins in any of the original peoples of

Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) - A person having origins in any of

the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having

origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of

the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China,

India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the

original peoples of North and South America (including Central America), and who maintain tribal

affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the

above five races.

VETERANS’ EMPLOYMENT PREFERENCE

Kalispell School District No. 5 and High School District

To claim preference under the Montana Veterans' Employment Preference Act, complete the following. Providing the information below is voluntary but must be included with the application in order to claim employment preference. This information will be kept confidential and will only be used during the hiring process to provide the applicant employment preference. Applicants hired by the school district will have this information placed in a separate confidential file.

Name:
Job Number: / Job Title:

To claim Veterans' Employment Preference you must be a U.S. Citizen and (check one of the areas below):

A Veteran, if

1. You have been separated under honorable conditions, AND have served more than 180 consecutive

days of active federal military duty other than for training in the Army, Air Force, Navy,Marines,

or Coast Guard or were a member of the reserves who served on federal military duty during a

period of war or in acampaign or expedition for which a campaign badge is authorized.

2. You are or have been a member of the Montana Army or Air National Guard who has satisfactorily

completed a minimum of 6years service in armed forces, the last 3 of which have been served in the

Montana Army or Air National Guard.

A Disabled Veteran, if

1. You have been separated under honorable conditions from military duty, AND

2. You have an established Armed Forces service-connected disability OR are receiving compensation,

disability retirementbenefits, or pension from the U.S. Department of Veterans Affairs or military

department, OR you have received aPurple Heart.

The spouse of a disabled veteran if the veteran's disability prevents him/her from working.

The unremarried surviving spouse of a veteran or disabled veteran.

The mother of a veteran, if

1. THE VETERAN died under honorable conditions while serving in the Armed Forces, OR THE

VETERAN has a service-connected,permanent, and total disability, AND

2. YOUR SPOUSE is totally and permanently disabled, OR YOU are the unremarried widow of the

father of the veteran.

In the box below, check the attachment you have included to document your eligibility for employment preference.

DD-214 showing the character of discharge

A document issued by the Office of the Adjutant General of the Montana National Guard certifying service.

Other:

______

Signature of Applicant Date

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