Support Application

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Full Name: *

First Name Last Name

E-mail:

Phone Number: *

Area Code Phone Number

Social Security Num. *

Address: *

How long at address

Applying for Position(s):

Are you authorized to work in the United States

Yes No Uncertain

When can you start?

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Have you ever worked for Altus Schools

Yes No

If Yes, provided dates of employment, and School Site

Have you ever worked with children?

Yes No

If Yes, explain

Do you have and friends or relatives working for Altus Schools, If yes, please list.

How where you referred to Altus Schools? Please list:

Do you speak a language other than English?

Yes No

If yes, please list all languages in which you speak.

Do you have any physical impairments that would interfere with your job performance?

Yes No

If yes, explain

Have you ever been convicted of a felony?

Yes No

If yes, explain in detail

Do you possess

Computer Skills Typing Skills Other Job Related Skills

Educational Experience: Please list all Schools Attended, Dates Attended, and Degrees Conferred:

Employment History: Please list: Name and Address of Employer, Name of Supervisor, Position, Salary, and Reason for Leaving for the past 10 years:

References: Please list the Name, Address, Occupation, and Phone Number of FOUR Non-Relatives

Upload your resume (optional):

Pursuant to Oklahoma State Statute 70: 5-142, the Altus Public Schools will conduct a State (Name) search on all newly employed persons in the district.

I understand that this application will remain active one year after its completion and that I must notify the district, in writing, if I wish to be considered beyond that point.

I authorize investigation of all statement contained in this application. I understand misrepresentation or omission of facts called for is cause for dismissal without notice at any time during my employment.

I agree, if employed, to follow all rules and regulations of the district.

I understand that the Board of Education may require a health certificate from a physician and further understand and agree that the physical will be at my expense.

Applicants Initials *

Enter the code as it is shown: *

AGREEMENT