SKACD
                                                       CLASSIFIED STAFF EMPLOYMENT APPLICATION


Notice to Applicant:

It is the policy of the Board of Directors of the SKACD Special Education Coop., No. 613, Ensign, 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:  
Social Security Number:  
   
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 certify that all the information provided by me in this application is true and complete. I understand that any misstatement, falsification, or omission of information is ground to hire or, if I am hired and the same is discovered thereafter termination.

I authorized any of the persons or organization referenced in this application to give you any and all information concerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability of any damages that may result from furnishing such information to you.

I authorize you to request receive, and verify all information given on this application and I release you from all liability for any damages that may result from our doing so.

I further acknowledge that if I am employed by the employer, my employment will be at will and may be terminated with or without cause at any time by me or by he employer.

YesNo