BROOKINGS SCHOOL DISTRICT APPLICATION FOR

EMPLOYMENT

BROOKINGS SCHOOL DISTRICT IS AN EQUAL OPPORTUNITY EMPLOYER

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions legibly and signed the back of the application. Use blank paper if you do not have enough room on this application. PLEASE PRINT OR TYPE, except for your signature on the back of the application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Job Applied for ______Today's Date ______

(If you are an unsuccessful candidate for this position, we will keep this application along with other supporting documents on file for future job openings, but we must receive notification from you to reactivate your file.)

Last Name First Name Middle Name
Present Street Address City State Zip Code
Permanent Street Address City State Zip Code
Telephone Number(s) / Social Security Number
| |
Email Address

List other name(s) under which you may have worked ______

Are you 18 years of age or older? Yes No (If you are hired, you may be required to submit proof of age.)

Males born after December 31, 1959, are required to register with the Selective Service. Are you registered

with the Selective Service?

If hired, when could you start work? ______

Have you ever applied here before? Yes No If yes, when? ______

Were you ever employed here? Yes No If yes, when? ______

Names of any relative currently employed by the school: ______

Have you ever been convicted of a felony? Yes No

If yes, give details ______

(A "Yes" answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying is also considered.)
It is the policy of the Board of Education that no otherwise qualified person will be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any district program or activity on the basis of race, religion, gender, gender identity, sexual orientation, age, national origin, or disability.

EDUCATION AND TRAINING

Name(s) and Address of School(s) / Indicate Years Completed / Graduated
Yes or No / GED or Type of Degree / Course of Study
List Major/Minor(s) / Expected Month/Year of Completion
High School(s) / 9 10 11 12 / Yes
No
Undergraduate College(s)
Dates Attended:
______to ______/ Yes
No
Graduate School(s)
Dates Attended:
______to ______/ Yes
No
Technical, Business, Correspondence, etc.
Dates attended:
______to ______/ Yes
No
Describe any specialized training, apprenticeship, skills, and extra-curricular activities.
______
______
______
______
______
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
______
______
______
State any additional information you feel may be helpful to us in considering your application.
______
______
______
ANSWER THIS QUESTION ONLY AFTER YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing the activities involved in the job
or occupations for which you have applied? A description of the
activities involved in such a job or occupation can be provided.
You will be required to meet the standards for the job or occupation. ______Yes ______No

PERSONAL REFERENCES

1. ______( ) ______
(Name) Phone #
______
(Address)
2. ______( ) ______
(Name) Phone #
______
(Address)
3. ______( ) ______
(Name) Phone #
______
(Address)

CONSENT AND RELEASE FORM

Employment

Record
List most
current or
recent employer
first, include
periods of
unemployment,
include U.S. Military
Service (show
rank/rate at
discharge).
Include previous
summer/part time
jobs and assignments and
any volunteer
experience which
relates to the
position for which
you are applying. / Employer (company name) / Immediate supervisor's name / Your job title
Street Address / Employment dates (mo. and yr.)
From To / Salary
Begin End
City, State, Zip Code / Reason for leaving or why do you want to leave?
Company's Product or Service / Summarize your job duties
Employer (company name) / Immediate supervisor's name / Your job title
Street Address / Employment dates (mo. and yr.)
From To / Salary
Begin End
City, State, Zip Code / Reason for leaving
Company's Product or Service / Summarize your job duties
Employer (company name) / Immediate supervisor's name / Your job title
Street Address / Employment dates (mo. and yr.)
From To / Salary
Begin End
City, State, Zip Code / Reason for leaving
Company's Product or Service / Summarize your job duties
Employer (company name) / Immediate supervisor's name / Your job title
Street Address / Employment dates (mo. and yr.)
From To / Salary
Begin End
City, State, Zip Code / Reason for leaving
Company's Product or Service / Summarize your job duties
Additional
Information / (Please include any additional information you think might be helpful to use in considering you for employment, such as additional work experience, activities, accomplishments, etc.)
Office Use Only
Application Received ______Interviewed by ______
Credentials Received ______Date Recommended ______School/Building ______
Transcripts Received ______Replacing ______Position ______
Step ______Extra Duty ______