Application for Certified Employment
Name
Your answer
SS#
Your answer
Physical Address
Your answer
Mailing Address
Your answer
Phone #
Your answer
Emergency #
Your answer
Have you every used a different name under prior employment or educational records? If yes, what name(s) did you use?
Your answer
Have you ever been convicted of a felony? If yes, give details.
Your answer
Health Status: Can you perform the duties of the job for which you have applied?
In your previous employment, did you have to miss more than two work days in a row? If yes, please explain:
Your answer
Position Desired:
Your answer
Certification:
Your answer
Endorsements:
Your answer
Education (list in order of attendance). Include: Name and location of school, years attended, date graduated, type of degree attained
Your answer
Work History (at least 3 years). Include: Name and address of employer, Dates employed, position held, reason for leaving
Your answer
List three NON-relative references to whom we may refer. Include: Name, occupation, address, phone number
Your answer
Please initial below if you agree to the following: I authorize investigation of all statements contained in this application. I understand misrepresentation or omission of facts called for is cause for dismissal without notice at anytime during my employment.I understand that my application will remain active for a period of one year from the date of application.
No application is given final consideration until the applicant has had a personal interview with an authorized representative of the school system.The Board of Education of District I-001, of Ottawa County, Wyandotte, Oklahoma is an equal opportunity employer and will not discriminate against any person because of race, sex, color, creed, handicap, or condition.
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