APPLICATION FOR EMPLOYMENT

Fill out the application carefully and completely. The information will assist us in determining your eligibility for employment.  Any additional information you wish to include must be attached to this application before submitted. 

Employment decisions are based solely upon the individual’s qualifications for the positions being filled.  The School District recruits, hires, and promotes for all job classifications without regard to race, color, creed, sex, age, national origin, or handicap.

Position desired:
1st Choice: _____________________________________________     2nd Choice: ____________________________________________________

PERSONAL
1. Name: ______________________________________________________________________________             S.S. No. _________________
                                 Last                                                                        First                                                                         Middle

Other names or maiden: _________________________________________________________________________________

2. Address where correspondence can be directed:
    ___________________________________________________________________________________________________________
        Number and Street/or P.O. Box                                                                                                      City                                                                             State                                         Zip

3. Telephone Number: Home: (     ) _________________     Work: (     ) _________________  

4. Are you at least 18 years of age? _____ Yes _____ No

5. Have you ever been convicted or pled “no contest” for any violation of law other than minor traffic offenses: (NOTE: A criminal record DOES NOT constitute an automatic bar to your being hired.)  _____ No _____ Yes. If so, when, where, and disposition of case: (Fingerprinting and/or a background check is a condition of employment in this district.)
_______________________________________________________________________________________________________________________

6. Have you made application with this school district before? _____ No _____Yes. 
    If so, when?____________ Under what name?___________________________________________________

7.  *Do you possess a valid Arizona driver’s license _____ Yes _____ No Class ___ 1 ___ 2 ___ 3 ___ 4
*The law requires bus drivers to be at least 21 years of age.
8. List any languages other than English which you speak fluently: ______________________________________________

9. List any languages other than English which you write fluently: _______________________________________________

10. List job related professional societies, licenses, registrations, and/or awards: _______________________________________________
_______________________________________________________________________________________________________________

11. Resume (Optional): _____ Attached _____ In transit

FOR CERTIFIED PERSONNEL ONLY

12. What Arizona certificate(s) do you hold?  Type of certificate (Elementary, Secondary, etc.)

Certificate	Date Issued	Date of Expiration	

			

If you do not hold an Arizona certificate, for what Arizona certificate are you eligible as informed by the Teacher Certification Services, Arizona Department of Education?
_____________________________________________________________________________________

EDUCATION

13.  Name of last High School	Address	Dates Attended	Diploma Obtained	
___________________________
	________________________________________	___________	__________	

14. Colleges/Universities	Address	Dates Attended	Major	Degree Obtained	
___________________________	_____________________________________	_______	_____________	_____________	
___________________________	_____________________________________	_______	_____________	_____________	
___________________________	_____________________________________	_______	_____________	_____________	

15. Technical or Business Schools	Address	Dates Attended	Area of Study	Diploma/Cert. Obtained	
___________________________	____________________________________	_______	______________	_____________	
___________________________	____________________________________	_______	______________	_____________	
___________________________	____________________________________	_______	______________	_____________	

EMPLOYMENT RECORD

16. List in order, starting with your most recent employment.

Name of Employer	Address	Dates	Supervisor	Position	Reason for Leaving	Phone

________________	________________________	_____	__________	________	___________________	__________	
________________	________________________	_____	__________	________	___________________	__________	
________________	________________________	_____	__________	________	___________________	__________	
________________	________________________	_____	__________	________	___________________	__________	
PROFESSIONAL REFERENCES

17.    Name	Present Address	Phone No.	Official Position at Present
	
_______________________	__________________________________	___________	_______________________________	
_______________________	__________________________________	___________	_______________________________	
_______________________	__________________________________	___________	_______________________________	
_______________________	__________________________________	___________	_______________________________	

18. List the name, address, and telephone number of the person to be contacted in case of emergency. (To be completed after employment.)

Name: ______________________________________________________________________________ 
Address: _____________________________________________________________________________
Telephone: (____)______________________________________________________________________

19. I hereby authorize each person, school district, firm, and corporation listed on my application to answer any questions that may be asked and to give any information that may be sought concerning this application, my work, habits, character, or skills. (We will not contact your current employer without your permission.)

20. If presently employed, may we contact your employer? _____ Yes _____ No

 I certify that to the best of my knowledge all answers and statements herein contained are true and I understand that any misstatement or omission of fact will subject me to dismissal or disqualification.

Signature _______________________________________________________  Date ________________

Rev: 062614