APPLICATION FOR EMPLOYMENT - CERTIFIED STAFF
Each item on this application is important. Please complete carefully and accurately.
Date of Application
PERSONAL INFORMATION
Name
Last First Middle
Current Address
Street City State/Zip Phone
Permanent Address
Street City State/Zip Phone
Additional phone numbers where you may be reached during the day
Social Security Number Driver’s License Number
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GENERAL INFORMATION
Position Desired
1. 2. 3.
Wisconsin Certification(s) Held WI DPI Code Expiration Date
EDUCATIONAL AND PROFESSIONAL TRAINING
Please list in order of attendance all education institutions attended.
Undergraduate Coursework
Name of Institution City/State Dates Enrolled Degree Major
Graduate Coursework
Name of Institution City/State Dates Enrolled Degree Major
Semester credits earned above your highest degree
STUDENT TEACHING
Dates School Location Nature of Position
PROFESSIONAL EMPLOYMENT HISTORY
Dates School Location Nature of Position
OTHER EMPLOYMENT HISTORY
Dates School Location Nature of Position
REFERENCES
(List two or more principals or supervisors who know your teaching ability.)
Name Title
School District Office phone
Address City State/Zip Home phone ******************************************************************************
Name Title
School District Office phone
Address City State/Zip Home phone ******************************************************************************
Name Title
School District Office phone
Address City State/Zip Home phone ******************************************************************************
Name Title
School District Office phone
Address City State/Zip Home phone ******************************************************************************
Are you currently under contract: Yes No
If yes, explain
Are you on layoff with recall rights? Yes No
If yes, when?
If yes, under what name?
Have you ever been convicted of a felony? Yes No
If yes, please explain by confidential letter.
Date available for employment
Date of Birth for Criminal Background Check
I certify that the answers given by me in this application are true and correct without omissions of any kind. I agree that the District shall not be held liable in any respect if my employment is terminated because of false statements, answers, or omissions made by me in this application. I authorize any former employer, person, firm, corporation or governmental agency to disclose to the New Lisbon School District any information they may have regarding me. I further authorize the New Lisbon School District to conduct a criminal background check. I understand that if I am offered employment, it will be contingent on the results of a drug screening test. In consideration of the School District's review of this application, I hereby release the District, as well as all providers of information, from any liability and for any damage which may result from the furnishing and receiving of this information. A copy of this authorization and release is as valid as the original and should be recognized as such.
Signature of Applicant Date
Thank you for completing this application and for your interest in employment with us.
The New Lisbon School District does not discriminate on the basis of sex, race, religion, age, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation, or physical, mental, emotional, or learning disability.
religion, age, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation, or physical, mental, emotional, or learning disability.
SEND APPLICATION AND LICENSE (IF APPLICABLE) TO:
School District of New Lisbon
Attn: Eileen Bunker, Administrative Secretary
500 S. Forest St.
New Lisbon, WI 53950
IN YOUR OWN HANDWRITING, please compose a summary of factors which, in your mind, will enhance your candidacy. Limit your comments to the area below.