GREEN BAY AREA PUBLIC SCHOOL DISTRICT 200 SOUTH BROADWAY

P. 0. BOX 23387 GREEN BAY, WISCONSIN 54305

(920) 448-2155 MAINTENANCE DEPARTMENT

APPLICATION FOR EMPLOYMENT

PLEASE PRINT OR TYPE Date

Nrune (Last.) (First)

State

Telephone Number Social Security Number

(Middle)

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Position Desired When Available

Would you accept temporary employment?

(Proof of Date of Birth will be requested upon employment.) ****************************************************************************************

TO BE FILLED OUT ONLY IF APPLYING FOR A SKILLED TRADE:

Apprenticeships served or trades learned:

Licenses held:

Capable of operating the following equipment:

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EDUCATION: High School - Technical Institute - College or University

Institution Location Course Dates of Attendance Diploma or Degree

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(over)

REFERENCES: People who can testify as to your character and ability, including person(s) in responsible positions in the last two places you worked.

Name Official Position Address I Zip Code Phone No.'

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Have you ever been convicted of any crime, including any ordinance violation (exclude traffic violations resulting in fines less than $25.00)? Yes No If yes, explain fully.

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My signature below certifies that all statements made on this application are true and complete to the best of my knowledge. If employed by this school district, I understand that any misrepresentation of factual information contained herein may be cause for dismissal.

Date Signature of Applicant

The Green Bay Area Public School District is an equal opportunity employer conforming with Title IX of Education Amendments of 1972; Title VII Civil Rights Act of 1974; Section 504 of the Vocational Rehabilitation Act of 1973; and, Wisconsin Fair Employment Act.

11/86

WORK EXPERIENCE: Give a complete record of your full time work experience. Indicate most recent experience at top of page, followed by previous experience in chronological order. Use a separate sheet of paper if additional space is needed. FROM MO. YR. ,TO: MO. YR. I NO. MONTHS TITLE OF POSITION I SALARY - STARTING FINAL NAME OF EMPLOYER DUTIES

ADDRESS

NAME OF SUPERVISOR REASON FOR LEAVING HAY WE CONTACT

FROM: MO. YR. I TO: MO . YR. I NO. MONTHS TITLE OF POSITION I SALARY- STARTING FINAL .

NAME OF EMPLOYER DUTIES

ADDRESS

NAME OF SUPERVISOR REASON FOR LEAVING HAY WE CONTACT

FROM: MO. YR. ITO: MO. YR. , NO. MONTHS TITLE OF POSITION

I

SALARY - STARTING FINAL

NAME OF EMPLOYER DUTIES

ADDRESS

NAME OF SUPERVISOR REASON FOR LEAVING HAY WE CONTACT

FROM: MO. YR. ITO: MO. YR. ' NO. MONTHS TITLE OF POSITION I SALARY - STARTING FINAL NAME OF EMPLOYER DUTIES

ADDRESS

NAME OF SUPERVISOR REASON FOR LEAVING HAY WE CONTACT

FROM: MO. YR. ,TO: MO. YR. I NO. MONTHS TITLE OF POSITION 1 SALARY - STARTING FINAL .

NAME OF EMPLOYER DUTIES

ADDRESS

NAME OF SUPERVISOR REASON FOR LEAVING HAY WE CONTACT

FROM: MO. YR. I TO: MO. YR. I NO. MONTHS TITLE OF POSITION I SALARY - STARTING FINAL ., . -.

NAME OF EMPLOYER DUTIES

ADDRESS

NAME OF SUPERVISOR REASON FOR LEAVING HAY WE CONTACT

FROM: MO. YR. ,TO: MO. YR. ' NO. MONTHS TITLE OF POSITION I SALARY - ST ART ING FINAL

NAME OF EMPLOYER DUTIES

ADDRESS

NAME OF SU .. ERVISOR REASON FOR LEAVING HAY WE CONTACT