Circle Unified School District 375
901 Main, PO Box 9, Towanda, KS 67144
(316) 541-2577
(316) 536-2249 (fax)
Professional Employment Application
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Applicant's Name: *
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SSN: *
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Address: *
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City, St, Zip *
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Phone Number: *
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Alt. Phone 1: *
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Email Address: *
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Alt. Phone: *
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Level of position Desired *
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Subject or grade desired: *
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Position 1 *
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Position 2
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Position 3
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Education History
List most recent first.
Name of Institution 1 *
City and State
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Degree 1 *
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Years Attended 1 *
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Year Graduated 1 *
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Name of Institution 2
City and State
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Degree 2
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Years Attended 2
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Year Graduated 2
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Name of Institution 3
City and State
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Degree 3
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Years Attended 3
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Year Graduated 3
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Type of Kansas Certificate Held 1 *
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Type of Kansas Certificate Held 2
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Type of Kansas Certificate Held 3
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Teaching Experience
Please explain any gaps in employment
Grade or Subject 1
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Name of District School, City 1
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Date of Employment Begin 1
From(Year)
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Date of Employment End 1
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Total Years 1
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Reason for Leaving 1
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Grade or Subject 2
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Name of District School, City 2
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Date of Employment Begin 2
From(Year)
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Date of Employment End 2
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Total Years 2
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Reason for Leaving 2
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Grade or Subject 3
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Name of District School, City 3
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Date of Employment Begin 3
From(Year)
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Date of Employment End 3
To(Year)
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Total Years 3
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Reason for Leaving 3
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Activities you can sponsor or coach
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References
Please do not use relatives
Name 1
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Address 1
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Phone Number 1
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Official Position 1
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Name 2
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Address 2
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Phone Number 2
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Official Position 2
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Name 3
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Address 3
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Phone Number 3
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Official Position 3
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Please provide additional information which you feel is pertinent to this application
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Have you ever been convicted of a felony? *
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Signature *
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Notice of Non‐Discrimination 
Circle USD 375 does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.  The following person has been designated to handle inquiries regarding the non‐discrimination policies: Don Potter, Superintendent, 901 Main, PO Box 9, Towanda, KS  67144, 316‐541‐2577 or dpotter@usd375.org
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