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Certified Staff Application

The only way to view a PDF document on our website, you have to have a google sign in. We are trying to copy and paste all documents in manually for those of you who don't have a sign in. Applications will be harder to fill out this way due to the lines moving around. The best way to apply is to email karla.schoenfish@k12.sd.us and I will email you an application to fill out and you can scan back or mail back.

CERTIFIED STAFF APPLICATION

BON HOMME SCHOOL DISTRICT #04-2

District Office, PO Box 28, 1404 Fir Street, Tyndall, SD 57066

 

Name ______________________________                 ______________________________            _____

                Last                                                                        First                                                                        M.I. 

 

Social Security Number: _____ - _____ - _____   Name as it is on Card: _____________________________________________

 

Position(s) for which you are applying: ___________________________________________________________________________

If we request an interview, when would be most convenient? __________________________________________________________

 

Present Address: ______________________________   City ____________________ State _________ ZIP ______________

At This Address Until _______________ Email Address ________________________________________________________

Home Telephone (____) _______________ Cell Phone (____) _______________ Best time to call __________

 

Place of Employment: ______________________________________________ May we contact you at work? _____ Yes _____ No

Work Telephone (____) _______________ Best time to call __________

 

Permanent Address: ______________________________ City ____________________ State _________ ZIP _______________

At This Address Until _______________ Email Address ________________________________________________________

Home Telephone (____) ______________ Cell Phone (____) _______________ Best time to call __________

 

 

 

Teaching Certificate: Number: ______________________________ Expiration Date: ____________________

Endorsement(s): ______________________________ Teaching Majors: ______________________________

Additional Subjects/Assignments: ______________________________________________________________________________

If you do not have a certificate, will you by September 1? _____ Yes _____ No

 

List co-curricular activities you may be interested in directing: _______________________________________________________

 

Are you currently under contract with another school district? _____ Yes _____ No

If yes, expiration date: _______________ May we contact your present employer? _____ Yes _____ No

 

Have you applied in Bon Homme #04-2 before? _____ Yes _____ No If yes, date: _______________

Were you employed in Bon Homme #04-2 before? _____ Yes _____ No If yes, date: _______________

 

 

 

Have you been convicted of a CRIME in the last 7 years? _____Yes _____ No (Conviction may be relevant if job related but does not necessarily bar you from employment). If yes, please explain: _________________________________________________________

___________________________________________________________________________________________________________

BH #04-2 requires a background check (including fingerprinting) through DCI for all new employees immediately after hire.

 

Do you have any past or current physical or mental health conditions which may affect the performance of your work?

_____ Yes _____ No If yes, please explain:

 

Physical Health ______________________________________________________________________________________________

___________________________________________________________________________________________________________

 

Mental Health _______________________________________________________________________________________________

___________________________________________________________________________________________________________

 

Are you a US citizen? _____ Yes _____ No  If no, do you have a Green Card? _____ Yes _____ No

 

Have you ever served in the United States Armed Forces? _____ Yes _____ No

If yes, indicate branch and discharge date: _________________________

 

Males born after December 31, 1959, are required to register for Selective Service. Are you registered? _____ Yes _____ No

 

 


 

List information regarding your interests, abilities, activities, and experience which you feel has a bearing on your qualifications for this position.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

 

 

Write a statement about why you are interested in teaching at Bon Homme School District #04-2.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

 

 

Briefly state your personal philosophy of education.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

 

To the Applicant

      A complete application includes a letter of application, resume, credentials, transcripts, and a copy of your South Dakota teaching certificate (if available). Your resume should include references (including student teaching), education, and work experience. If it does not, please list on a separate sheet of paper and attach to this application form. If your credentials do not include a recommendation from your immediate supervisor or cooperating teacher, please have that individual send a letter of recommendation.

      We appreciate sincerely the time and interest you have given in making application to the Bon Homme School District.  We assure you that your application will receive prompt consideration.

      Bon Homme School District is an equal opportunity employer. The Bon Homme School District does not discriminate against any employee on the basis of sex, race, religion, national origin, age, height, weight, marital status, or handicap/disability unrelated to the employee's ability to perform his/her job.

 

 

I verify that the information given by me in this application is true, accurate, and complete. I understand that if I have given any false information on this application or if I have omitted any material fact, I may be disqualified from employment with Bon Homme School District, or if hired, I may be discharged upon discovery of such false statement(s) or omission(s). I understand that my employment with Bon Homme School District may be subject to a reference/background check. I hereby authorize Bon Homme School District to investigate the truthfulness of all statements made on this application and/or contact my former employer(s) and other listed reference(s) or any other person(s) who can verify any information submitted to Bon Homme School District in support of my application for employment. I hereby waive any right that I may have against any person contact by Bon Homme School District, including former employers who provide information concerning this application and I release each said person from liability for providing information. 

 

________________________________________                      ______________________________

Signature                                                                                               Date 

 

 

 

PERSONNEL OFFICE USE ONLY

Position(s) applied for___________________________________________________    Date(s) ______________________________

Interviewed by_____________________________________ Date__________    Employed: _____ No_____ Yes    Date __________

 

 


EMPLOYMENT   DATA   RECORD

 

Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital status, veteran status, medical condition, handicap, or any other legally protected status. As an Equal Opportunity Employer, we comply with government regulations.  

 

The purpose for this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information, please note that all Data Records are kept in a Confidential File and are not a part of your Job Application or personnel file.  

 

Please note: Your cooperation is voluntary. Inclusion or exclusion of any data will not affect any employment decision.

 

 

VOLUNTARY SURVEY

Please Print                                                                 Date ____________________

 

Name____________________________________________________________________________________

            Last                                                                 First                                                     M.I.

 

Street Address/PO Box: _____________________________________________________________________

City _____________________________      State __________       ZIP _______________

Social Security Number: ____________________

 

Current Job: _______________________________________________________________________________

 

Check One:     _____ Male     _____ Female

 

Age __________

 

Check One Of The Following (Ethnic Origin):

            _____White    _____ Hispanic           _____ American Indian/Alaskan Native

            _____Black     _____ Other                _____ Asian/Pacific Islander 

 

Check If Any Of The Following Are Applicable:

_____ Vietnam Era Veteran   _____Disabled Veteran          _____Handicapped Individual 

 

 

 

OFFICE USE ONLY

Position(s) applied for is open: _____ Yes _____ No

Position(s) considered for: ___________________________________________________________

Date(s) __________________________________________________________________________

 

 

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