APPLICATION FOR NON-CERTIFIED PERSONNEL



APPLICATION FOR NON-CERTIFIED PERSONNEL

The Wall School District 51-5 does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. An equal opportunity employer.

Wall School District 51-5 (Please type or use black ink.)

P.O. Box 414

Wall, SD 57790-0414 Date: ______________________

Phone: (605) 279-2156

I. PERSONAL DATA

Name of Applicant _____________________________________________________________________________

(Last) (First) (Middle)

Present Address _______________________________________________________________________________

(Street) (City) (State) (Zip)

Social Security Number _______________________________ Telephone ________________________________

Do you have duties that would interfere with your acceptance of any assignment for the good of the system, or attending meetings or participating in other activities outside of the work hours, which are related to the general school program?

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Have you ever been employed by the Wall School District? ________________________When? ______________________

Have you ever been convicted of a felony or any offense involving moral turpitude?* _______________________________

If yes, please explain: __________________________________________________________________________________

____________________________________________________________________________________________________

*A conviction will not necessarily be a bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into consideration.

Have you previously filed an application with the Wall School District? __________________________________________

If so, give the date: ____________________________________________________________________________________

II. EMPLOYMENT DATA

What type of work are you applying for (be specific)? _________________________________________________________

Salary Desired? ______________________ Will you accept temporary employment? _______________________________

When could you begin work? ____________________________________________________________________________

Previous Work Experience – begin with most recent

Employer Telephone Assignment Dates From – To

____________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

In what line of work are you experienced or do you have particular training?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List any experience you have operating machines or equipment. (Examples: Secretary-computer, copy machines; Custodian-floor scrubbers, etc.; Cook-mixers, big ovens, etc.; Teacher Aide-computers, copy machines, A.V. equipment.)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What is the highest grade or degree of education completed? __________________________________________________

List any specialized education or training

Name & Location of School Years attended Course Pursued Degree Date

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

III. REFERENCES

Name Position Complete Mailing Address Telephone

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

___________________________________________________

Applicant’s Official Signature

__________________________________

Date

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