MAINTENANCE/CUSTODIAL APPLICATION

(Fill in all blanks)

Name_____________________________________ Date___________________________

Address__________________________________________________________________________

Street or Box City State Zip Code

Home Telephone_____________________ Message Telephone____________________

Are you a citizen of the United States? Yes____ No____

Social Security Number_______________________

Are you presently employed? Yes____ No____ By Whom?______________________

EDUCATION PREPARATION

List schools you attended High Schools & Colleges	Address	When? Give Dates	How long? Months Year	Did you graduate? Give degree

Job Preference (circle) Skills

Custodian Electrician__________________________

Maintenance Plumber____________________________

Carpenter___________________________

Heavy Equipment_____________________

Other_______________________________

Have you been issued a journeyman card? Yes___ No___

If yes, give the card number________________________________

Expiration date of card_____________________________________

EMPLOYMENT RECORD: Give the names of firms for whom you have worked, beginning with the most recent. Fill in completely, as all former employers may be asked to verify your employment.

Dates From To	Employer’s Name	Address & Phone No.	Nature of Position	Annual Salary	Reason for Leaving

PERSONAL REFERENCES: Give the name of three (3) persons, who are not relatives and who have known you for at least two (2) years.

Name	Address & Phone Number	Official Position

IMPORTANT – PERSONAL AUTOBIOGRAPHY

Attach to this application a separate sheet of paper on which is a short personal autobiography containing any information you think will assist us in arriving at a true estimate of your qualifications for the position you seek. Be sure to include your reason for seeking a position with this school system and why you left your last position. The personal autobiography must be in your own handwriting.

Silver Consolidated Schools is an Equal Opportunity Employer. Applications are considered without regard to race, gender, creed, age, national origin or disability.

Applications will remain active for 90 days from the date they are received and may be renewed for an additional 90 days by providing a written request to the personnel office.

READ AND SIGN

I certify that answers given herein are true and complete to the best of my knowledge. I understand any false statements or misrepresentation of facts are grounds for dismissal.

If understand and agree that any offer of employment that I may receive from the Silver Consolidated School District is conditioned upon the District’s receipt of information pursuant to a criminal background check of myself.

I hereby authorize the Silver Consolidated School District to investigate my work history and education history, and to conduct personal reference inquiries. Any person or entity providing information is released from any and all claims or liability for compliance.

I further authorize the Silver Consolidated School District to release to any potential employer and all relevant information concerning my job history.

______________________________________________ _________________________

Signature of Applicant Date Revised 04/01/2010