Non-Certified Personnel Application

EMPLOYMENT APPLICATION NON-CERTIFIED PERSONNEL

Central Plains USD 112
Date (MM/DD/YYYY)
Last Name
First Name
Middle
Address
Street
City, State, Zip
Home Telephone

Area Code Phone Number
Business Telephone

Area Code Phone Number
Email Address
Are you over the age of 18?

Yes No
Specific Position Applied for
Education
High School
Name
Location
Dates Attended
Diploma or Degree
College or University
Name
Location
Dates Attended
Diploma or Degree
Business or Trade
Name
Location
Dates Attended
Diploma or Degree
Other
Name
Location
Dates Attended
Diploma or Degree
Work Experience

List all Experience
Employer Information
Do you have any relatives who work for USD112 Central Plains or who serve on the Board of Education?

Yes No
If yes, please state their names and your relationship:
Have you ever been convicted of or pled guilty or nolo contendre to a felony or any offense involving moral turpitude?

Yes No
If yes, please explain:
Moral turpitude is an act of baseness (meanness), vileness (evil) or depravity (corruption) in the private and social duties which a person owes another member of society or society in general and which is contrary to the accepted rule of right and duty between persons, including, but not limited to theft, attempted theft, murder, rape, swindling and indecency with a minor. (Conviction of a crime is not an automatic bar to employment.)
Why are you seeking to change positions or why did you leave your last position?
Have you ever been dismissed or asked to resign from employment?

Yes No
If yes, please explain:
Are you aware of any reason you would not be able to perform the duties required of the position for which you are applying?

Yes No
If yes, please explain:
References

(Please list three persons not related to you, whom you have known at least one year.)
List any additional information regarding your knowledge, skills and experience relative to the job for which you are applying.
Electronic Signature: Type full Name
Date of Electronic Signature (MM/DD/YYYY)
Should be Empty:

EMPLOYMENT APPLICATION NON-CERTIFIED PERSONNEL