USD 459 Bucklin Schools

Please complete form for consideration of employment. If you have any questions, please contact Emily Evans, BOE Clerk, at eevans@usd459.org or (620) 826-3828.

Unified School District #459 is an Equal Employment Opportunity Agency and does not discriminate on the basis of sex, color, race, religion, national origin, disability, or age, in admission or access to, or treatment or employment in, its programs or activities.

Classified Staff Application

Date of Application

Position Applying for

Last Name

First Name

Middle Initial

Reaquired field: Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Phone Number

Prior Employment Information

Employer

Position

Employment Dates

Reaquired field: Address Info:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reason for Leaving

May we contact this employer?

Reaquired field: Yes

Reaquired field: No

Employer

Position

Employment Dates

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reason for Leaving

May we contact this employer?

Reaquired field: Yes

Reaquired field: No

Employer

Position

Employment Dates

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reason for Leaving

May we contact this employer?

Reaquired field: Yes

Reaquired field: No

Attach additional infomation, if needed.

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Educational Information

Please list your high school and college education in chronological order.

High School

Graduation Year

College

Location

Graduation Year

Diploma / Degree

Course of Study

Special Training, if any:

Special Honors, if any:

Attach addition information, if needed.

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Personal Information

Summarize special job-related skills and qualifications acquired from employment or other experiences.

State briefly your reasons for wishing to be an employee in our district.

References

Please list three people who may be contacted to give current information on your qualifications to this position

Reference #1

Name

Position

Phone Number

Reaquired field: Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Relationship

Years Known

Reference #2

Name

Position

Phone Number

Reaquired field: Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Relationship

Years Known

Reference #3

Name

Position

Phone Number

Reaquired field: Address Info.

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Relationship

Years Known

Resume

Please upload current resume here.

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Acknowledgments

1. I certify that all the information provided by me in this application is true and complete. I understand that any mistatement, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination.

2. I authorize any of the persons or organizations 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 for any damages that may result from furnishing such information to you. I authorize any background checks by any third party.

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

4. I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete such investigation and I release you from all liability for any damages that may result from your doing so.

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