Application Form

Bulldog

Employment Application

 

Applicant Information

Last Name


First


M.I.

Date


Street Address


Apartment/Unit #


City


State


ZIP


Phone


E-mail Address


Date Available


Social Security No.


Desired Salary


Position Applied for


Are you a citizen of the United States?

YES 

NO 

If no, are you authorized to work in the U.S.?

YES 

NO 

Have you ever worked for this company?

YES 

NO  

If so, when?


Have you ever been convicted of a felony?

YES 

NO 

If yes, explain



Education

High School


Address


From


To


Did you graduate?

YES 

NO 

Degree


College


Address


From


To


Did you graduate?

YES 

NO 

Degree


Other


Address


From


To


Did you graduate?

YES 

NO 

Degree



References

Please list three professional references.

Full Name


Relationship


Company


Phone

(           )

Address


Full Name


Relationship


Company


Phone

(           )

Address


Full Name


Relationship


Company


Phone

(           )

Address






























 

Previous Employment

Company


Phone

(           )

Address


Supervisor


Job Title


Starting Salary

$

Ending Salary

$

Responsibilities


From


To


Reason for Leaving


May we contact your previous supervisor for a reference?

YES 

NO 


Company


Phone

(         )

Address


Supervisor


Job Title


Starting Salary

$

Ending Salary

$

Responsibilities


From


To


Reason for Leaving


May we contact your previous supervisor for a reference?

YES 

NO 


Company


Phone

(         )

Address


Supervisor


Job Title


Starting Salary

$

Ending Salary

$

Responsibilities


From


To


Reason for Leaving


May we contact your previous supervisor for a reference?

YES 

NO 



Military Service

Branch


From


To


Rank at Discharge


Type of Discharge


If other than honorable, explain



Disclaimer and Signature

I certify that the information given on this application and in any other supporting documentation and resume is true and correct.  I understand that any false information and/or willful negligent failure to disclose any requested information will constitute sufficient grounds to terminate my employment without notice.

I authorize my previous employers, schools, and persons named as references to give any information regarding my employment together with information they may have regarding me, whether or not it is in their records.  I agree that USD #316, Golden Plains and its employees and my previous employers and their employees shall not be held liable in any respect if an employment offer is not tendered, is withdrawn, or my employment is terminated because of false statements, answers, or omissions made by me in this application.  I hereby release said employers, schools, or persons from all liability for any damages whatsoever for issuing this information.

Signature


Date






















 

USD 316 is an equal opportunity employer and shall not discriminate in its employment practices and policies with respect to hiring compensation, terms, conditions, or privileges of employment because of an individual’s race, color, religion, sex, age, disability or national origin. 

The Board shall hire employees based on ability and the district’s needs.