USD 243 Lebo-Waverly
Email address *
Phone: 785-733-2651 BOX 457 Waverly, KS 66871
Classified Staff Employment Application
Application Date:
Full Name
Social Security Number
Present Street Address
Present City
Present State
Present Zip Code
List any other name(s) you may have been known by which would be required to verify any of the information contained in this application.
Position Applying For:
Would you accept temporary or part-time employment?
Would you like to added to the substitute list for the above position(s) you applied for?
Date Available for employment
Have you been dismissed or asked to resign from employment?
If yes to the previous question, please explain.
Have you ever been convicted of a Misdemeanor?
Have you ever been convicted of a Felony?
If you answered Yes to the previous question, please state the nature of the crime(s), when and where convicted and disposition of the case on the "Others" field on the last question.
High School (Name of school) (Location) (Dates Attended)
College (Name of school) (Location) (Dates Attended)
Work Experience (Please list the jobs that you have held, most recent job in the first space) (Name of Firm or Organization) (Address & Phone Number) (Supervisor's Name) (Dates Employed) (Reason for Leaving)
List persons who know your abilities and about your general qualifications. There persons may be contacted by telephone or by written correspondence. At least three (3) recent references are requested.
Name and Title Phone # Address
Name and Title Phone # Address
Name and Title Phone # Address
Other Information deemed necessary to complete this application:
I certify that all the information provided by me is this application is true and complete. I understand that any misstatement, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination.

I authorize any of the person or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release al such parties from all liability for any damages that may result from furnishing such information to you. I authorize any background checks by third party.

I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete such investigation, and I release you from all liability for any damages that may result from your doing so.

I understand that if I am offered provisional employment in the school district, that my fingerprints may be taken, and a request made for a state and national criminal background check. I further understand that if the results of this criminal history check reveal that I have been convicted of any offense or any attempt to commit any offense specified in K.S.A. 1999 Supp. 72-1397, and amendments thereto, that my employment may be terminated.

in Lieu of a signature, enter mother's maiden name:
A copy of your responses will be emailed to the address you provided.
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