U.S.D. 309 does not discriminate on the basis of sex, race, color, national origin, handicap or age in admission or access to, or treatment, or employment in its programs or activities. Any questions regarding U.S.D. 309’s compliance with Title VI, Title IX, or Section 504 including information about the existence and location of services, activities, and facilities that are accessible to and useable by disabled persons may be directed to the Business Manager, who can be reached at (620)663-7141, 4501 W. Fourth St., Hutchinson, KS 67501, or to the Superintendent of U.S.D. 309.
|
| First Name |
|
| Middle Initial |
|
| Last Name |
|
|
| Address: |
|
| City State Zip |
|
| Telephone: |
|
|
| List specific positions you're applying for: |
|
|
|
Have you ever been convicted of a felony or entered a plea of “no contest” to a felony charge?
Yes
No |
| If yes, explain |
|
|
|
Have you applied here before?
Yes
No |
| If yes, when? |
|
| Position |
|
|
Type of work desired (check all that apply)
Full-time
Part-time
Year-round
School term only
Summer Only |
| When could you begin employment? |
|
| Salary desired? |
|
| When could you come in for a personal interview? |
|
| Present Position |
|
| Present Salary |
|
| Present Employer |
|
| Supervisor's Name |
|
| Address |
|
| Telephone |
|
| May we contact your present employer for a reference?
Yes
No |
| General condition of health |
|
| Number of work days missed last year? |
|
| Describe any conditions that would prohibit your performance of duties required in the position for which you are applying. |
|
| Name and address of nearest relative not living with you: |
|
| If related to any employee of U.S.D. 309, state name and position. |
|
| Educational Background: |
| Elementary School Name: |
|
| Location: |
|
| Years Attended: |
|
| Diploma Date: |
|
|
| High School Name: |
|
| Location: |
|
| Years Attended: |
|
| Diploma Date: |
|
|
| College Name: |
|
| Location: |
|
| Years Attended: |
|
| Diploma Date/Hours Earned: |
|
|
| Trade, Business, or Vocational School Name: |
|
| Location: |
|
| Years Attended: |
|
| Diploma Date/Hours Earned: |
|
|
| Employment Experience: |
| Date Employed: |
|
| Employer Name/Address: |
|
| Salary: |
|
| Position Held: |
|
| Work Performed: |
|
| Reason for Leaving: |
|
|
| Date Employed: |
|
| Employer Name/Address: |
|
| Salary: |
|
| Position Held: |
|
| Work Performed: |
|
| Reason for Leaving: |
|
|
| Date Employed: |
|
| Employer Name/Address: |
|
| Salary: |
|
| Position Held: |
|
| Work Performed: |
|
| Reason for Leaving: |
|
|
| Date Employed: |
|
| Employer Name/Address: |
|
| Salary: |
|
| Position Held: |
|
| Work Performed: |
|
| Reason for Leaving: |
|
|
| Professional References |
| Name: |
|
| Business: |
|
| Address: |
|
| Telephone: |
|
| Years Acquainted: |
|
|
| Name: |
|
| Business: |
|
| Address: |
|
| Telephone: |
|
| Years Acquainted: |
|
|
| Name: |
|
| Business: |
|
| Address: |
|
| Telephone: |
|
| Years Acquainted: |
|
|
|