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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