PULLMAN SCHOOL DISTRICT NO. 267

240 SE Dexter Street • Pullman, WA 99163

Personnel Office (509) 332-3584 • FAX (509) 334-0375

Website:

APPLICATION FOR CLASSIFIED

PARAPROFESSIONAL EMPLOYMENT

DATE:

DESIGNATE THE TYPE OF EMPLOYMENT FOR WHICH YOU ARE APPLYING:

Fulltime  InstructionalParaprofessional

Part-timeTitle I

Substitute  Special Education

 Learning Assistance Program (LAP)

Building

 Playground Paraprofessional

 Other: ______

BUILDING PREFERENCE: Franklin Elementary Jefferson Elementary Sunnyside Elementary

Lincoln Middle School PullmanHigh School  No Preference

PERSONNEL INFORMATION

Last Name / First Name / MI
Other Names Used / Social Security No.
Temporary Address / City / State / Zip
Permanent Address / City / State / Zip
Telephone / Message number / Email
CERTIFICATION
Type / Number / Date Issued / Expiration Date
Driver’s License
Commercial License
Food Handler’s Permit
First Aid Certificate
CPR Certificate
Other
EDUCATION AND TRAINING(List most recent first)
Name of Institute
City, State / Dates Attended
Mo/Yr to Mo/Yr / Degree / Date of Degree / Major / Minor / GPA
MILITARY EXPERIENCE
Branch of Service / Duties / Dates
Mo/Yr to Mo/Yr / Total Years

EMPLOYMENT EXPERIENCE(List most recent experience first)

Employer Name and Supervisor / Dates: Mo/Yr to Mo/Yr / Reason for Leaving
From:
To:
Address, City, State, Zip, Phone Number / Position Title / Major Duties:
Employer Name and Supervisor / Dates: Mo/Yr to Mo/Yr / Reason for Leaving
From:
To:
Address, City, State, Zip, Phone Number / Position Title / Major Duties:
Employer Name and Supervisor / Dates: Mo/Yr to Mo/Yr / Reason for Leaving
From:
To:
Address, City, State, Zip, Phone Number / Position Title / Major Duties:
Employer Name and Supervisor / Dates: Mo/Yr to Mo/Yr / Reason for Leaving
From:
To:
Address, City, State, Zip, Phone Number / Position Title / Major Duties:
Employer Name and Supervisor / Dates: Mo/Yr to Mo/Yr / Reason for Leaving
From:
To:
Address, City, State, Zip, Phone Number / Position Title / Major Duties:
Employer Name and Supervisor / Dates: Mo/Yr to Mo/Yr / Reason for Leaving
From:
To:
Address, City, State, Zip, Phone Number / Position Title / Major Duties:

REFERENCES(Professional only – do not list friends or relatives)

Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:
Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:
Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:
Name / Position / Relationship
Address , City, State / Zip / Telephone
Home:
Business:

•I hereby authorize the PullmanSchool District to make any investigation of my personal or employment history and authorize any former employer, person or organization to give PullmanSchool District any information regarding me. I release the PullmanSchool District, its employees and/or agents and all providers of information from any liability as a result of furnishing and receiving this information.

• I certify that the information presented in this application is true and complete to the best of my knowledge and I have read and understand that I have authorized the district to conduct reference checks. I understand if I am employed, false statements on this application may be cause for dismissal.

Signature Date

PULLMANSCHOOL DISTRICT MAINTAINS A TOBACCO FREE AND DRUG FREE ENVIRONMENT

The Pullman School District does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth groups. The following employee has been designated to handle questions and complaints of alleged discrimination: Assistant Superintendent, Pullman School District Administrative Offices, 240 SE Dexter Street, Pullman, WA 99163, (509) 332-3144, . Applicants with disabilities may request reasonable accommodations in the application process by contacting the Human Resources Manager at (509) 332-3584.

PULLMANSCHOOL DISTRICT IS AN EQUAL OPPORTUNITY EMPLOYER