Hampton Dumont Community School Online Job Application
APPLICATION FOR EMPLOYMENT - We are an EEO/AA Employer
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Today's Date *
MM
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DD
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Position applying for *
Phone Number *
Email Address
Please provide an email address for communication purposes
First Name *
Middle Initial *
Last Name *
Street Address *
City *
State *
Zip *
Are you legally able to work in the United States? *
Military/Veteran Status *
If YES please compete the starting date and discarge date
Starting Date
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DD
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Discharge Date
MM
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Have you ever been convicted of a felony, or misdemeanor? *
The term "convicted" includes a conviction following a trial, a guilty plea, a plea of nolo contrendere or no contest, a deferred judgment or adjudication, and an adjudication of guilt or delinquency as a minor. If you indicate yes, please submit an explanation of the conviction on a separate sheet of paper.
Are you now or have you ever been on the Sex Offender Registry? *
Are you now or have you ever been on the Child Abuse or Adult Dependent Abuse Registry? *
It is the policy of the Hampton-Dumont Community School District not to discriminate on the basis of race, color, national origin, sex, disability, religion, creed, age (for employment), marital status (for programs), sexual orientation, gender identity and socioeconomic status (for programs) in its educational programs and its employment practices. There is a grievance procedure for processing complaints of discrimination. If you have questions or a grievance related to this policy please contact the district’s Equity Coordinator, Jen Koenen, Curriculum Director, 601 12th Ave. NE, Hampton, Iowa, 50441, (641) 456-2175, jkoenen@hdcsd.org.
Education *
Select highest grade completed
Name and location of the school *
Years of College
Select from the list below
Name and location of the college attended
Area of Study
List subjects studied and degree(s) received (Major/Minor)
What language(s) do you speak and/or write fluently?
1. Employment History
Previous employer
1. Street Address
Address of previous employer
1. City
1. State
1. Zip
1. Date started
MM
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DD
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YYYY
1. Date left
MM
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DD
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YYYY
1. Job Title/Duties, Hourly Rate/Salary
Please enter the position held and wage information below.
1. Reason for leaving
Please indicate your reason for ending employment
2. Employment History
Previous employer
2. Street Address
Address of previous employer
2. City
2. State
2. Zip
2. Date started
MM
/
DD
/
YYYY
2. Date left
MM
/
DD
/
YYYY
2. Job Title/Duties, Hourly Rate/Salary
Please enter the position held and wage information below.
2. Reason for leaving
Please indicate your reason for ending employment
3. Employment History
Previous employer
3. Street Address
Address of previous employer
3. City
3. State
3. Zip
3. Date started
MM
/
DD
/
YYYY
3. Date left
MM
/
DD
/
YYYY
3. Job Title/Duties, Hourly Rate/Salary
Please enter the position held and wage information below.
3. Reason for leaving
Please indicate your reason for ending employment
References-Other than friends or relatives *
Please provide at least "three" references and include their name, relationship to you, and telephone number.
Please click on the link to upload other application documents listed below
Terms of Employment *
I hereby agree that the statements made by me in this application and all related information which I have provided are true, accurate, and complete to the best of my knowledge. I understand that if I provide any false, inaccurate, or incomplete information or fail to disclose information requested, I will not be eligible for employment, or if I am hired, I will be subject to disciplinary action or dismissal regardless of the date on which the employer discovers the violation regarding application form dishonesty.
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