Little Beavers Application

Staff Application

Each item on this application is important. Please complete carefully and accurately.
Date of Application

MonthDayYear
Date
Position(s) for which you are applying
Applications will only be accepted when a vacancy is posted.
Name

First NameMiddle NameLast Name
Social Security #
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Additional phone number where you may be reached
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If above address changed in the last five years, please list previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date available for employment

MonthDayYear
Date
Have you filed an application with this school district within the last year?
If yes under what name and when.
Include a resume of qualifications.

Cancelof
College transcripts or certificates must be provided by the applicant where applicable.

You can share certificates, diplomas etc.
Cancelof
Describe any other education or training (vocational, business, apprenticeships, correspondence courses, etc.)
Please list in order of attendance all education institutions attended.
Institution City /State Degree Major Minor
Previous Work Experience
Previous Work Experience
Previous Work Experience
References
References
References
Do you have a parent, spouse, son, daughter, sister, brother, brother-in-law, son-in law, sister-in law, daughter-in-law, step-parent and/or grandparent currently employed by the Augusta School District in a supervisor’s position?
If yes, please indicate the name of the individual, your relationship to the person and their current supervisor’s position with the district.
Have you ever been convicted of a crime?
If you are recommended for employment a criminal background check and physical entrance examination must be satisfactorily completed before you will be hired. In order to complete a criminal background check in the State of Wisconsin we need to know your date of birth

MonthDayYear
Date of Birth
I certify that the answers given by me in this application are true and correct without omission of any kind. I agree that the district shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in the application. I authorize the school district to make any investigation of my personal or employment history and authorize any former employer, person, firm, corporation or governmental agency to disclose to the school district any information they may have regarding me. In consideration of the school district’s review of this application, I hereby release the district as well as all providers of information from any liability and for any damage that may result from the furnishing and receiving of this information. A copy of this authorization and release is as valid as the original and should be recognized as such.
Signature
The Augusta School District will keep employment applications on file for one year. If a vacancy exists, all applications pertaining to that position will be pulled and considered for the vacancy. After one year, all applications and any materials attached thereto shall be destroyed.

The Augusta School District is an equal opportunity employer. The District does not discriminate on the basis of sex, race, color, religion, creed, age, national origin, ancestry, pregnancy, marital status or parental status, sexual orientation, disability or other factors provided for by state and federal laws.

Reasonable Accommodation

Reasonable accommodation, including the provision of informational material in an alternative format, will be provided for qualified individuals with disabilities upon request.

To request accommodation, please contact Katie Hagen, (715)286-7037, or Augusta School District, E19320 Bartig Rd., Augusta, WI 54722. Email: khagen@augusta.k12.wi.us
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Staff Application