Zumbro Education District

Zumbro Education District

Applicant Information Form

No application for employment at the Zumbro Education District is considered complete unless accompanied by this form. Print and complete this form in its entirety and send to the Zumbro Education District along with a letter of interest and resume.

It is the policy of the Zumbro Education District to provide equal employment opportunity for all, without discrimination on the basis of race, color, creed, religion, national origin, gender, marital status, status with regard to public assistance, disability, sexual orientation, or age.

Name: Date:

Address:

Home Phone: Cell Phone:

Gender: Male FemaleE-Mail Address:

Position Applying For:

If you hold a Minnesota teaching license, please provide folder number:

Have you previously worked for the Zumbro Education District? Yes No

If so, please provide dates and position held:

How did you hear about the position?

Do you have any special needs which may necessitate accommodations in the application/interview process? Yes No

If so, please describe the type of accommodation requested:

Are you currently employed? Yes No

If so, may we contact your current employer? Yes No

Date you would be available to begin work:

Are you either a U.S. citizen or legally eligible to hold employment in

the U.S.? Yes No

Are you a veteran of the Armed Forces of the United States or are you otherwise eligible

to claim Veteran’s Preference Points? Yes No

Do you wish to claim Veterans’ Preference Points? Yes No

(Proof of veteran or disabled veteran status by submitting applicant’s DD214 form will be required before preference will be granted.)

In accordance with the Minnesota Government Data Practices Act, the Zumbro Education District is required to inform you of your rights as they pertain to the private information collected from you. Private data is that information which is available to you but not the public. The information collected from you or other agencies or individuals authorized by you is used to review your qualifications for employment. The dissemination and the use of the private data we collect is limited to that necessary for administering a program of equal opportunity in employment.

Have you ever been convicted of a felony? Yes No

Effective May 1, 2009, and in accordance with M.S. 123B.03, Subd. 1(a), school boards and other hiring authorities must require prospective teachers to include, as part of their employment applications, information on any current or previous disciplinary actions taken in Minnesota and other states against their teaching licenses as a result of sexual misconduct with students. Failure to disclose such information will be grounds for the teacher’s dismissal.

Has the Board of Teaching in Minnesota or any other state taken action against you (the teacher) for a board determination that sexual misconduct or attempted sexual misconduct occurred between you (the teacher) and a student? Yes No

If you are offered a position with the Zumbro Education District, you will be required to complete a background check.

Are you Hispanic/Latino (choose only one)

No, not Hispanic/Latino

Yes, Hispanic/Latino (a person of Cuban, Mexican, Puerto Rican, South or Central

American or other Spanish culture or origin, regardless of race)

The above question is about ethnicity, not race. No matter what you selected above, continue to answer the following by marking one or more boxes indicating what you consider your race to be:

What is your race? (choose one or more)

American Indian or Alaska Native(a person having origins in any of the original peoples of

North and South America, or Central America, and who maintains tribal affiliation or community attachment)

Asian(a person having origins in any of the original peoples of the Far East, Southeast Asia

or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam)

Black or African American(a person having origins in any of the black racial groups of

Africa)

Native Hawaiian or Other Pacific Islander(a personal having origins in any of the original

peoples of Hawaii, Guan, Samoa, or other Pacific Islands)

White(a person having origins in any of the original peoples of Europe, the Middle East, or

North Africa)

Zumbro Education District, 801 Frontage Rd NW, Byron, MN 55920