MUPU SCHOOL DISTRICT
4410 N. Ojai Rd., Santa Paula, CA 93060
(805) 525-6111
APPLICATION FOR EMPLOYMENT IN THE CLASSIFIED SERVICE
Position Desired: ______
NAME ______
(Last) (First) (Middle)
ADDRESS ______
(Number) (Street) (City) (State) (Zipcode)
PHONE NUMBERS Day: ______Evenings: ______
Are you employed now? Yes __ No __ Date Available For Work: ______
EDUCATION AND TRAINING
Circle Highest Grade Completed: 8 9 10 11 12
High School Attended ______
(Name) (City/State)
College ______Graduated? Yes ___ No ___
(Name)
______
(Course of Study) (Degree Received)
Other ______
(Name) (Course of Study)
SKILLS
SPEAK READ WRITE
Languages Fluent In ______
______
Machines Operated: ______
Technical Skills: ______
______
______
Mupu School District
Classified Application
EMPLOYMENT EXPERIENCE
Start with your present or most recent job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.
Employer Telephone( ) / Dates Employed / Work Performed
From / To
Address
Job Title / Hourly Rate/Salary
Starting / Final
Supervisor
Reason for Leaving
Employer Telephone
( ) / Dates Employed / Work Performed
From / To
Address
Job Title / Hourly Rate/Salary
Starting / Final
Supervisor
Reason for Leaving
Employer Telephone
( ) / Dates Employed / Work Performed
From / To
Address
Job Title / Hourly Rate/Salary
Starting / Final
Supervisor
Reason for Leaving
Employer Telephone
( ) / Dates Employed / Work Performed
From / To
Address
Job Title / Hourly Rate/Salary
Starting / Final
Supervisor
Reason for Leaving
If you need additional space, please continue on a separate sheet of paper.
Mupu School District
Classified Application
Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience:
______
______
______
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes ___ No ___
All new personnel are required to have a criminal record clearance. Falsification of any information on an application may be cause for immediate dismissal.
Have you ever been convicted of a felony? Yes ___ No ___ If yes, explain:
______
______
Do you have a valid California Driver’s License? Yes ___ No ___
Do you have any physical or mental conditions which might limit your ability to perform the duties and responsibilities of the position for which you have applied? Yes ___ No ___
If yes, please explain ______
______
EQUAL OPPORTUNITY EMPLOYER
After appointment, proof of American Citizenship or proof
of legal right to work in the United States is required.
REASONABLE ACCOMMODATION FOR PERSONS WITH A DISABILITY: Individuals with disabilities requiring reasonable accommodation in the testing process must inform Mupu, by phone (525-6111) no later than the filing date stated on the announcement. If you have not notified us by the deadline, it is assumed no special accommodations are needed.
I hereby certify that all statements made hereon are true and correct to the best of my knowledge and authorize investigation of all statements here recorded. I release from all liability persons and organizations reporting information required by this application.
______
Signature Date
2