SCHOOL DISTRICT OF MISHICOT
660 WASHINGTON STREET MISHICOT, WI 54228 APPLICATION FOR EMPLOYMENT
(for all Mishicot School District Positions)
The School District of Mishicot considers applicants for all positions without regard to race, color, sex, religion, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.
Date of Application_____________________________ Position Applying for: ___Teaching ___ Substitute Teaching ___Custodial ___ Cleaner ___ Part Time Cleaner
___ Bus Driver ___ Food Service ___ Clerical ___Instructional Ass’t. ___ Other Substitute
Last Name
First Name
Middle
Street Address
City
State
Zip
Telephone Number
Social Security Number
Are you legally eligible for employment in the United States? Have you ever been employed with us before? Yes ____ No
Yes ____ No If yes, give date(s)
Have you ever been convicted of a crime (Other than traffic violations)? Yes ____ No Are you currently employed? Yes ____ No On what date would you be available for work? Driver License Number
EMPLOYMENT RECORD
Name of Employer and Address Employed From Date To Date Position Held
Do you give permission to allow the School District of Mishicot to review your records with D.O.T. and/or other State and Federal Agencies? Yes ____ No May we contact your present or past employers? Yes ____ No If no, please indicate those you do not wish us to contact by placing a check by the employer above, along with a brief explanation or your reasons (use backside of this application if needed)
EDUCATION
High School Undergraduate College/University Graduate College/University
School Name and Location Years Completed Diploma/Degree Course of Study (College) 9 10 11 12 1 2 3 4 1 2 3 4
Describe any honors you have received State any additional information you feel may be helpful to us in considering your application
List positions for which you hold a License
List professional, trade, business or civic activities and office held
Have you ever had any job-related training in the United States military? Yes____ No____ If yes, please describe
REFERENCES
Give name, address, and telephone number of three references who are not related to you and are not previous employers. 1. 2. 3.
Signature of Applicant
Date
Teacher Applicants: Please have your placement bureau send a copy of your credentials and mail this application to: Superintendent School District of Mishicot 660 Washington Street Mishicot, WI 54228
FOR PERSONNEL DEPARTMENT USE ONLY Interview scheduled? Employed? Yes ____ No ____ Date of Employment ____________________ Hourly Rate/Salary ______________________ Date _______________________________
Yes ____ No ____
Job Title ____________________________ By ________________________________
Applications will be kept on file for one year from date of application
You have been asked to supply private or confidential information concerning yourself to the School District of Mishicot. The school district intends to use the requested personal information for the purpose of selection and hiring of individuals for positions within the district. You may refuse to supply the requested personal information, however, the consequences which may arise from your refusing to supply the requested personal data may be non-selection for position for which you are applying. The following persons or entities are authorized by state or federal law to receive the data: Board of Education, Superintendent of Schools, Building Principals, Transportation Coordinator, Head of Buildings and Grounds and Confidential District Office Personnel. Form Date: 1/13/94 Revised: 9/01/05