USD 503

Parsons District Schools

2900 Southern Blvd

P.O. Box 1056

Parsons, KS 67357

Phone: 620-421-5950

Fax: 620-421-5954

CLASSIFIED STAFF EMPLOYMENT APPLICATION

Position for which you are applying:

Date of Application: Date available for Employment:

Name:

(List all names by which you have been known)

Address:

Phone Number(s):

Email:

Have you previously been employed by Parsons USD 503? Yes No

If yes, please give job title:

Do you have any relative employed by Parsons USD 503? Yes No

If yes, please give their name and relationship to you:

EDUCATION

Name of last High School attended:

Address:

Did you receive your diploma? Yes No

Did you get your GED? Yes No

Name(s) of College or University, City & State, Dates Attended, Field of Study, Hours, & Degree(s):

EMPLOYMENT

Starting with the most recent, list work experience.

Dates of Employment:

Name of Employer:

City & State:

Position:

Reason for Leaving:

Dates of Employment:

Name of Employer:

City & State:

Position:

Reason for Leaving:

Dates of Employment:

Name of Employer:

City & State:

Position:

Reason for Leaving:

Have you ever been dismissed or asked to resign from employment? Yes No

If yes, please give name of employer, date and reason for dismissal:

REFERENCES

Please list three persons you authorize Parsons District Schools to contact for references concerning your qualifications. Please include current employeror last employer if not currently employed, address and phone number:

Have you ever been convicted of a violation of law other than a minor traffic violation and/or entered into a sentence modification or diversion agreement? Yes No

If yes, please explain:

Have you ever had a driver’s license revoked or suspended? Yes No

If yes, please explain:

Are there any criminal charges or proceedings pending against you? Yes No

If yes, please explain:

Have you been convicted of any offense involving sexual molestation, physical or sexual abuse or rape?

Yes No

If yes, please explain:

Do you have any impairments including physical, mental or medical that would interfere with your ability to do the job for which you have applied? Yes No

If yes, please explain:

Are you aware of any contagious or communicable disease that you may have which might endanger others? Yes No

If yes, please explain:

PHYSICAL REQUIREMENTS/ENVIRONMENTAL CONDITIONS

  • Requires prolonged sitting or standing.
  • Occasionally requires physical exertion to manually move or push heavy objects or materials and can include stooping, bending and reaching.
  • Must work indoors and outdoors in noisy and crowded environments.

AUTHORIZATION

By affixing my signature, I affirm that all information set forth in this application is accurate, truthful and complete. I authorize Parsons USD 503 to make any investigation of my personal or employment history and authorize any former employer, person, firm, corporation, credit agency, or government agency to give Parsons USD 503 any information they may have regarding me. In consideration of Parsons USD503’s review of this application, I release Parsons USD503 and all providers of information for any liability as a result of furnishing and receiving this information.

SignatureDate

Parsons District Schools provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Parsons District Schools complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Parsons District Schools expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Parsons District School’s employees to perform their job duties may result in discipline up to and including discharge.

Revised 2-16-2016

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