Ashwaubenon School District SUPPORT STAFF APPLICATION

Human Resources Office 1055 Griffiths Lane, Ashwaubenon, WI 54304 Telephone: (920) 492-2905, extension 1004 Fax: (920) 492-2911

Check the box(s) below for those areas for which you want to be considered. D Food Service D Clerical

D Aide D Custodial

D Noon Duty Supervisor D Substitute

TODAY'S DATE:

* * * * * * * * * * * * PERSONAL DATA * * * * * * * * * * * *

NAME: (Last) (First) (Middle)

PRESENT ADDRESS: ~~~~~~~~~~~~~~~~~~~~~ Street City ZIP

PHONE NUMBER:

SOCIAL SECURITY NUMBER:

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Date available for employment:

Work History: (Please list information for only the last five years. Your immediate supervisor may be contacted by us unless you state otherwise.) NAME OF"FIRM/ ORGANIZATION PHONE NO.

NAME OF SUPERVISOR

TYPE OF WORK DONE

DATES El\1PLOYED

Ashwaubenon is an equal opportunity district, functioning under non-descrimination policies. 8/3/99

SUPPORT STAFF APPLICATION Page -2-

EDUCATIONAL PREPARATION AND TRAINING (Secondary & Post Secondary Only) Name & Location of School Attended Dates Attended

Credits and/or Degree Received

Why do you wish to work for the Ashwaubenon School District?

Other Information

List work experiences that you have had that you feel may better qualify you for this position:

Any additional remarks:

List three references.

Name

1. 2. 3.

Telephone Relationship Or Position

I certify that the above statements are true to the best of my knowledge.

Signature Date

Ashwaubenon is an equal opportunity district, functioning under non-descrimination policies. 8/3/99