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Application for Certified Personnel
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An Equal Opportunity Employer
2207 N. 10th Independence, KS 67301
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Name: (First, Middle Initial, Last) *
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Address: *
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Home Phone or other contact:
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1st Preference: Position and/or Subject Desired *
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2nd Preference: Position and/or Subject Desired
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3rd Preference: Position and/or Subject Desired
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If you are a former employee of Tri-County, please list your name at the time of employment and dates of employment:
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Are you a KPERS retiree? *
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