WAUSA PUBLIC SCHOOLS - Educational Service Unit #1



WAUSA PUBLIC SCHOOLS

Wausa, Nebraska 68786

APPLICATION FOR EMPLOYMENT (CLASSIFIED)

Date of Filing Application____________________

Name ______________________________________________Soc. Security #__________________

(Last) (First) (Middle)

Present Address _____________________________________________________________________

Street City State Zip

How many years have you lived at this address? _______________ Telephone (_____)____________

Previous Address _______________________________How long did you live there?_____________

Job(s) applied for: 1.____________________________ Rate of pay expected $________ per ______

2. ____________________________ Rate of pay expected $ ________per ______

How did you learn of this opening? _____________________________________________________

Do you want to work ______full-time or ______ part-time?

Specify days and hours of part-time: ____________________________________________________

Have you worked for us before?_____________ if yes, when? ________________________________

High School Diploma: Yes ______ No ______ College: Yes _______ No ________

If hired, on what date will you be available to start work? ______________________________________

If applicable for the position you are applying for: Do you use shorthand?______ Can you type? _______

Are there any other experiences, skills, or qualifications which you feel would especially fit you for work with our school? _______________________________________________________________________

_____________________________________________________________________________________

If hired, do you have a reliable means of transportation to get to work?_________________________

Have you had a serious illness in the past five years? Yes ______ No __________

(Describe) ____________________________________________________________________________________________________________________________________________________________________

Have you ever been convicted of a crime, excluding misdemeanors and summary offenses?

Yes ______ No______ If yes, describe in full.____________________________________________

__________________________________________________________________________________

(over)

Prior Work History:

|Dates |Dates |Name & Address |Rate of Pay |Supervisor’s Name |Reason for Leaving |

|From |To |Of Employer |Start and Final |& Phone number | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

May we contact the employers listed above? _________ If not, indicate which one(s) you do not wish us to contact _______________________________________________________________________

__________________________________________________________________________________

Person To Be Notified In Case of Accident or Emergency

Name _______________________________________ Phone _______________________________

Relationship __________________________________ Address ______________________________

______________________________________________

Signature of Applicant

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Interview: Yes ______ No_____ Date ____________________ Hour _____________

Result of Interview __________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________

Acceptable for Employment? _____________________ Starting Rate ________________________

Starting Date ___________________________________

Interviewed by: _________________________________ Approved by: _______________________

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Return to: Superintendent of Schools

Wausa Public School

P. O. Box 159

Wausa, NE 68786

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