Classified Staff (Para) Application for Employment

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.

* denotes a required field

This is an update to my existing application. Today's Date:

Personal Information

First Name:    MI: Last Name:

Address:

City: State:  ZIP:

Phone: 

Position Applying for:

Work location preference:

Have you read the Job Description for this position? Yes No

Are you able to perform the essential functions of this position with or without accommodation? Yes No

Are you willing to accept part-time or temporary employment? Yes No

Date available for work:

Criminal Legal History

Have you ever been convicted of a misdemeanor &/OR a felony charge?  Yes No

If you answered yes, please provide the date of the conviction and explain charges.

Education

  Name of School  Location   Graduation/Completion Date
High school      
College  
Other  
Completed GED    

Please describe any special skills you have.

Employment History

Company Name Address Phone Dates of Employment
   
     
       

References

Please list 3 references and their contact information.

Reference Name Relationship Length of time known Phone
       
       
       

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.

Yes