Mupu School District

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.

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