Medicine Lake School District #7

MEDICINE LAKE PUBLIC SCHOOLS
P.O. BOX 265
MEDICINE LAKE, MT 59247
406-789-2211

Classified Employee Application

Classified Employee Application

PERSONAL INFORMATION

Last Name

First Name

Middle Name

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Best Telephone Number:

Other Telephone Number:

Email Address:

Date of Application:

POSITION INFORMATION

Specific position for which you are applying:

Other positions for which you are qualified:

Coaching/advising interest and experience:

Are you presently under contract?

Date Available:

PLEASE ANSWER THE FOLLOWING QUESTIONS

Do you have the legal right to work in the United States?

Are you able with or without reasonable accomodation to perform the functions of the job for which you are applying?

What types of equipment, which relate to the position for which you are applying, can you operate?

What job related skills do you possess that you feel will help you perform the tasks of this job?

Describe the type of work you do best.

Have you ever been released or discharged from employment or resigned to avoid such release or discharge?

If yes, please explain, include date of discharge or resignation and reason for discharge or resignation:

I hereby certify that (check the applicable box and provide the information requested):

Reaquired field: I have not pleaded guilty to or have been convicted of any violation of criminal law, including criminal convictions resulting from a deferred sentence or a plea of nolo contendere/no contest (minor traffic offenses excepted).

Reaquired field: I have pleaded guilty to or have been convicted of at least one violation of criminal law. Please attach and sign a complete description of the circumstances surrounding such conviction.

All statements and information provided within this application and its attachments, if any, are true and complete. I understand that omission or misrepresentation of material fact may result in refusal of or separation from employment.

Applicant Name

Date:

REFERENCES

Please list current information for at least three and no more than four references below.

Reference #1

Full name:

Company:

Relationship:

Phone number:

Email address:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reference #2

Full name:

Company:

Relationship:

Phone number:

Email address:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reference #3

Full name:

Company:

Relationship:

Phone number:

Email address:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reference #4

Full name:

Company:

Relationship:

Phone number:

Email address:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

EDUCATION

Institution #1 (most recent):

Name of Institution:

Location:

Date attended-FROM:

Date attended-TO:

Degree awarded:

Major:

Minor:

Institution #2

Name of Institution:

Location:

Date attended-FROM:

Date attended-TO:

Degree awarded:

Major:

Minor:

Institution #3

Name of Institution:

Location:

Date attended-FROM:

Date attended-TO:

Degree awarded:

Major:

Minor:

Institution #4

Name of Institution:

Location:

Date attended-FROM:

Date attended-TO:

Degree awarded:

Major:

Minor:

Additional education information can be uploaded at the end of this application.

EMPLOYMENT RECORD

List your present or most recent employer. Describe your employment history, accounting for all time during at least the last 10 years. You may include volunteer and paid experience. DO NOT substitute a resume. You may attach additional information.

Employment #1 (most recent)

Employer/Company:

Immediate supervisor and title:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Employer telephone number:

Employer email address:

Employment date-FROM:

Employment date-TO:

Your job title:

Job duties-brief statement. Be sure to include all duties related to this position.

Reason for leaving:

Salary:

Do you wish to be notified before we contact this employer?

Employer #2

Employer:

Immediate supervisor and title:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Employer telephone number:

Employer email address:

From:

To:

Your job title:

Job duties-brief statement. Be sure to include all duties related to this position.

Reason for leaving:

Salary:

Do you wish to be notified before we contact this employer?

Employer #3

Employer:

Immediate supervisor and title:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Employer telephone number:

Employer email address:

Employment date-FROM:

Employment date-TO:

Your job title:

Job duties-brief statement. Be sure to include all duties related to this position.

Reason for leaving:

Salary:

Do you wish to be notified before we contact this employer?

Employer #4

Employer:

Immediate supervisor and title:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Employer telephone number:

Employer email address:

Employment date-FROM:

Employment date-TO:

Your job title:

Job duties-brief statement. Be sure to include all duties related to this position.

Reason for leaving:

Salary:

Do you wish to be notified before we contact this employer?

Employer #5

Employer:

Immediate supervisor and title:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Employer telephone number:

Employer email address:

Employment date-FROM:

Employment date-TO:

Your job title: Copy

Job duties-brief statement. Be sure to include all duties related to this position.

Reason for leaving:

Salary:

Do you wish to be notified before we contact this employer?

Employer #6

Employer:

Immediate supervisor and title:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Employer telephone number:

Employer email address:

Employment date-FROM:

Employment date-TO:

Your job title:

Job duties-brief statement. Be sure to include all duties related to this position.

Reason for leaving:

Salary:

Do you wish to be notified before we contact this employer?

Employer #7

Employer:

Immediate supervisor and title:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Employer telephone number:

Employer email address:

Employment date-FROM:

Employment date-TO:

Your job title:

Job duties-brief statement. Be sure to include all duties related to this position.

Reason for leaving:

Salary:

Do you wish to be notified before we contact this employer?

Additional work experience can be uploaded at the end of this application.

Equal Opportunity Employer

Medicine Lake Public Schools prohibit discrimination against or harassment of any person employed by or seeking employment with the school district because of race, creed, religion, color, political affiliation or national origin or because of age, physical or mental disability, marital status, or gender when the reasonable demands of the position do not require an age, physical or mental disability, marital status, or gender distinction. People of disability may request reasonable accommodation in the hiring process by contacting the school district personnel office.

Proof of Employability

Any applicant chosen for employment must be able to produce a social security card, driver's license, or some other acceptable form of verification of employment eligibility in the United States pursuant to Form I-9 of the U.S. Department of Justice. Similarly, a selected applicant must provide a set of fingerprints and be subject of a national fingerprint-based criminal history record check.

Authorization to Release Employment Records

If employed by a participating school district, the applicant authorizes the school district to supply his/her employment record at the school district's sole discretion, in whole or part, to any prospective employer, government agency, or other party, when the school district's interest is deemed appropriate.

Drug Free/Tobacco Free Policies

Medicine Lake School Districts are drug free, tobacco free schools and, as such, require all employees to adhere to specific drug free, tobacco free policies.

Acknowledgement

I understand that no offer of benefits, such as, but not limited to, a pension plan, insurance, vacation, or salary rate, is final until it has been reviewed by , and fully approved by the board of trustees or designated authorized representative. Further, I have read and understand the above policies of employment.

Applicant

PLEASE READ THIS SECTION BEFORE SIGNING

Affirmative Action Information

Providing this information is strictly on a voluntary basis. State law requires that employers keep records on the race and sex of applicants and employees to facilitate the enforcement of equal employment opportunity laws. This statement will be filed separately from all of your other employment records. As required by state law, it will be available only to the school district personnel department and federal/state employment enforcement officers.

Applicant

Date

If needed:

Additional Education Experience

Upload

Additional Work Experience

Upload

Cover Letter/Resume

Upload

Additional Information

Email a copy to

optional

Required Fields

Medicine Lake

Medicine Lake

Classified-Non-Teaching Application