CLASSIFIED STAFF EMPLOYMENT APPLICATION


Notice to Applicant:

It is the policy of the Board of Directors of the ANW Special Education Coop., No. 603, Humboldt, Kansas to assure equal opportunity to qualified individuals regardless of their race, religion, color, sex, disability, national origin, ancestry, or age, and to promote the full realization of equal employment opportunities to everyone. 

This policy covers all aspects of the employment relationship including recruitment, hiring, replacement, promotion, transfer, training and apprenticeship, compensation, layoff, termination, and harassment.

Application must be filled out completely.  All fields are required.
 
Today's Date:  
First Name:  
Middle Initial:  
Last Name:  
Street Address:  
City:  
State:  
Zip Code:  
Phone Number:  
   
Position Applying For:
 
Working Location Preference:
Have you read the position description for this job:
 		 Yes
No
Are you able to perform the essential functions of this position with or without accommodation?
 		 Yes
No
Would you accept temporary or part-time employment?
 		 Yes
No
Date Available?
 
Have you ever been convicted of a felony?  If yes, please explain by confidential letter.
 		 Yes
No
   
Education
  Name of School Location Graduation Date Date of GED Completion
High School
College  
Other  
   

Employment History

Please list the jobs you have held. List most recent job in the first space.

Name of Company Address and Phone Dates Employed Reason for Leaving

Please list any special skills:

REFERENCES

List below persons who know about your abilities and your general qualifications.  Qualifications of applicants under consideration may be investigated by correspondence.  Five recent references are requested.
 
Name and Title Address and Phone Number
   

AGREEMENT

 I understand that if I am offered provisional employment in the school district/ANW Special Education Cooperative that my fingerprints may be taken and a request made for a state and national criminal background check. I further understand that if the results of this criminal history check reveal that I have been convicted of any offense or any attempt to commit any offense specified in K.S.A. 1999 Supp.72-1397 any amendments thereto that my employment may be terminated.

YesNo