Unified School District #333
Classified Application Form
Equal Opportunity Employer

The information provided herein will become part of the employee's personnel record if employed by this district. It is only one component of a prospective applicant's file for employment. 

Check all appropriate blanks: Substitute for:
Clerical Clerical
Custodial/Maintenance Custodial/Maintenance
Food Service Food Service
Paraprofessional Paraprofessional
Teacher Aide Teacher Aide
Bus Driver Bus Driver
CAP Teacher Aide CAP Teacher Aide
Other -  Specify  Other -  Specify 

Date of Application

Name

Street City State Zip

Phone Social Security Number
                                                                                                   Optional Unless Hired

EDUCATION:

High School, College or University City/State Dates Attended Diploma/Degree

EXPERIENCE:

Employer Dates Type of job Reason for leaving

Describe any special skills or training which are applicable to this job.

Are you capable of performing the essential functions of the job?    Yes        No

 

PERSONAL REFERENCES (required)

Name & Title

Phone

Address

Additional Information for School Bus Driver Applicants
Drug Testing Is Required For All Bus Driver Applicants

Current Driver's License Type

Operator Chauffeur Commercial Other

License Number: State:

Have you had any type of vehicle accident in the last 10 years? YES NO
If yes, give brief description of the accident(s) and approximate date(s):

Have you been arrested for a moving traffic violation in the last 10 years? YES NO
If yes, give a brief description of the violation(s) and approximate date(s):

 

Have you been convicted in any state or federal court of any felony involving another person or any crime involving a child within the past 10 years? YES NO
If yes, give a brief description of the conviction(s) and approximate date(s).

Have you been convicted in any state of any major traffic violation which include; hit and run driving; driving under the influence of alcohol or drugs; vehicular homicide; reckless driving; or any offense for which the driver's license was suspended or revoked?  YES NO
If yes, give a brief description of the conviction(s) and approximate date(s).

Have you driven a vehicle other than a car? YES NO

Type of Vehicle Years Experience
 

Affidavit of Continuous Residency
State of Kansas                  )
County of   )
By submitting this on-line application, I certify that the following information is true and complete.
1.  I have been a permanent resident of the State of Kansas for the past  year(s).
2.  I have resided at the following addresses for the last 10 years:  (List most recent first.)
Address (Street, City, Zip)                                                    From                           To
    
    
    
    
    
    
    
    

I understand by submitting this application, I am giving Unified School District 333 authorization to obtain my driving record through a local law enforcement agency, the Kansas Department of Revenue, Division of Vehicles, or in states other than Kansas through a local law enforcement agency or the appropriate agency of the other state.

Have you been interviewed previously by USD 333?         Yes             No
Approximate date of that interview: