Cotter Public SD - AR - Classified Personnel Application

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06.19.13

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COTTER PUBLIC SCHOOLS
Classified Personnel Application
P.O. Box 70 Cotter, Arkansas 72626
Telephone 870.435.6171 Fax 870.435.1300

Personal

All potential employees are evaluated without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of a non-job related handicap or any other legally protected status.

* Position Sought:

* Date Available

* Name

First Name

Last Name

First Name / Middle Initial / Last Name

* Address

Address 1

Address 2

City

State

Zip Code

* Phone

- -

(XXX)-XXX-XXXX

Cell Phone

- -

(XXX)-XXX-XXXX

Email Address

* Are you a citizen of the United States?

Yes No

If no, are you authorized to work in the US?

Yes No

* Have you ever worked for this company?

Yes No

If yes, when?

* Have you ever been convicted of a felony?

Yes No

If yes, please explain

* Have you ever been involuntarily terminated or asked to resign from previous employment?

Yes No

If yes, please explain

Education

High school

Address

Address 1

Address 2

City

State

Zip Code

Did you graduate?

Yes No

Degree

College

Address

Address 1

Address 2

City

State

Zip Code

Did you graduate?

Yes No

Degree

Additional Education

Address

Address 1

Address 2

City

State

Zip Code

Did you graduate?

Yes No

Degree

Other trainings, certficiations, or licenses held:

References

* Name of Reference 1

First Name

Last Name

First Name / Last Name

* Relationship

Company

* Phone

- -

(XXX)-XXX-XXXX

* Address

Address 1

Address 2

City

State

Zip Code

* Name of Reference 2

First Name

Last Name

First Name / Last Name

* Relationship

Company

* Phone

- -

(XXX)-XXX-XXXX

* Address

Address 1

Address 2

City

State

Zip Code

* Name of Reference 3

First Name

Last Name

First Name / Last Name

* Relationship

Company

* Phone

- -

(XXX)-XXX-XXXX

* Address

Address 1

Address 2

City

State

Zip Code

Employment History

Most Recent Employment

Address

Address 1

Address 2

City

State

Zip Code

Phone

- -

(XXX)-XXX-XXXX

Supervisor

First Name

Last Name

First Name / Last Name

Job Title

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact this employer?

Yes No

Previous Employer

Address

Address 1

Address 2

City

State

Zip Code

Phone

- -

(XXX)-XXX-XXXX

Supervisor

First Name

Last Name

First Name / Last Name

Job Title

Responsibilities

Start Date

End Date

May we contact this employer?

Yes No

Reason for Leaving

Previous Employer

Address

Address 1

Address 2

City

State

Zip Code

Phone

- -

(XXX)-XXX-XXXX

Supervisor

First Name

Last Name

First Name / Last Name

Job Title

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact this employer?

Yes No

Previous Employer

Address

Address 1

Address 2

City

State

Zip Code

Phone

- -

(XXX)-XXX-XXXX

Supervisor

First Name

Last Name

First Name / Last Name

Job Title

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact this employer?

Yes No

Military Service

Branch

Enlistment Date

Date of Discharge

Rank of Discharge

Type of Discharge

If other than honorable, please explain

Disclaimer and Signature

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employement as may be necessary in arriving at an employment decision.

This application for employment shall be considered actived for a period of time not to exceed two (2) years.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

*

By submitting this form you are providing an electronic signature that is providing the same permissions as a signed original.

Acknowledge
Does not acknowledge

* Signature

* Date

We are an Equal Opportunity Employer