Non-Certified Personnel Application

Date (MM/DD/YYYY)

Last Name

First Name

Middle

Address

Street

City, State, Zip

Home Telephone

Area CodePhone Number

Business Telephone

Area CodePhone Number

Email Address

Are you over the age of 18?

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?

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?

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?

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?

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)

EMPLOYMENT APPLICATION NON-CERTIFIED PERSONNEL