Lisbon Public Schools

School District No. 19

502 Ash Street - Box 593

Lisbon, North Dakota 58054-0593

Phone: (701) 683-4106

High School Fax: (701) 683-4414

Middle School Fax: (701) 683-4111

"Providing Equal Opportunities for Employees and Students"

The Lisbon Public Schools are an Equal Opportunity/Affirmative Action Employer. It is the policy of our school to comply fully with all federal, state, and local equal employment laws. The school shall provide equal employment for all persons regardless of race, creed, sex, national origin, and age marital status, status with regard to public assistance, religion, or condition of health or disability.

PLEASE TYPE OR PRINT Please complete this entire application.

Position Applying For: / Name (First, Middle, Last): / Other names under which you have attended school or been employed:
Street Address: / City, State & Zip:
Social Security Number: / Home Phone: / Cell Phone: / Texting Available:
Yes No
Email Address :
Are you either a U.S. citizen or an alien who has the legal right to work in the position for which you are applying? / Yes No
Have you lived at the above address for less than one year? / Yes No / If yes, previous address:
If required for position, do you have a valid driver’s license? / Yes No / If YES, State of issuance, license #, and expiration date:

EDUCATION

Name of School

/

City/State

/ Did you graduate? / If No, # of years left to graduate / If Yes, date of Graduation / Degree received / Major

High School:

/ Yes No

GED:

/ Yes No
Other School: / Yes No

College:

/ Yes No
College: / Yes No

College:

/ Yes No
Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying.

SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)

WORK EXPERIENCE-Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”

PLEASE Note: Lisbon Public Schools reserve the right to contact all current

and former employers for referenceinformation.

Dates Employed (most recent position)
From: To / Full time Part time
If part-time, # hrs./wk: / Title:
Reason for leaving / Organization Name and Address:
May we call?
Supervisor’s Name, Title and Phone #: / Primary Duties:
Dates Employed (most recent position)
From: To / Full time Part time
If part-time, # hrs./wk: / Title:
Reason for leaving / Organization Name and Address:
May we call?
Supervisor’s Name, Title and Phone #: / Primary Duties:
Dates Employed (most recent position)
From: To / Full time Part time
If part-time, # hrs./wk: / Title:
Reason for leaving / Organization Name and Address:
May we call?
Supervisor’s Name, Title and Phone #: / Primary Duties:

REFERENCES: Please list Business and/or Personal References (Do not list relatives).

Name and Current Address Type of Acquaintance Telephone #
Name and Current Address Type of Acquaintance Telephone #
Name and Current Address Type of Acquaintance Telephone #

If you have been convicted, pled guilty, or pled “no contest” in a civil, criminal, or military

court for any reason other than minor traffic violations, please explain below. Note: A

yes answer does not automatically disqualify you from employment since the nature of the

offense, date, and type of position for which you are applying will be considered.

Charge Date Court Location

APPLICANT AUTHORIZATION

I hereby authorize the Lisbon Public School District their normal pre-employment inquiries as

described. This authorization is valid for one year from this date and any inquiries made after

that date will require a new signed release. I agree that withholding pertinent information or

submitting false information in connection with this application for employment constitutes

valid grounds for dismissal and loss of all employee benefits and privileges. I understand

that acceptance of this application for Fort Ransom School neither expresses nor implies that

I will be given employment. I acknowledge that I have read and understand the above.

I hereby certify that the above statements are true and complete to the best of my ability and belief.

Applicant Signature: ______Date: ______