Alcester Hudson
Alcester Hudson
Alcester Hudson
Please print plainly or type. Supplemental material may be attached to this form if you wish to submit additional information. You must fully
and accurately complete this application for employment.
PERSONAL DATA:
NAME
LAST FIRST MIDDLE
ADDRESS
STREET CITY STATE ZIP
EMAIL ADDRESS
PHONE ( ) ( )
HOME CELL/BUSINESS
Have you been previously employed by Alcester-Hudson School District #61-1? Ο Yes Ο No
EDUCATION:
Higher Education: Start with present or most recent and work back, including vocational/technical education.
1. Graduate: Ο Yes Ο No
Name of Institution
2. Graduate: Ο Yes Ο No
Name of Institute
3. Graduate: Ο Yes Ο No
Name of Institute
CERTIFICATION/LICENSE:
List any work related certifications, registration and/or license.
SKILLS INVENTORY: This section should be completed only if it relates to your position.
Do you speak, read, or write any language other than English? Ο Yes Ο No
If yes, identify
WORK EXPERIENCE: List all positions held. Start with the most recent. Use additional sheet, if necessary.
Entire application must be completed for consideration.
1.
Name of Firm/School/College University Phone Position
2.
Name of Firm/School/College University Phone Position
3.
Name of Firm/School/College University Phone Position
Which of these employers can we contact for a reference regarding your job performance?
REFERENCES: List educational, business, and/or professional references other than persons listed above.
1.
Name Organization
2.
Name Organization
3.
Name Organization
4.
Name Organization
I understand and agree that employment constitutes acceptance of the terms and conditions specified in the Board Policy Manual
in effect at Alcester-Hudson School District. I further understand that the language used in this application is not intended to
create, or is it to be construed to constitute any sort of contract between Alcester-Hudson School District #61-1 and applicants for
this position.
I, the undersigned, hereby duly authorize Alcester-Hudson School District officials to investigate all statements in this application
and included in my resume, and to secure any necessary information from all my subordinates, employers, and references,
organizations, and academic institutions. I further authorize and consent to those persons, organizations, educational institutions,
and employers to divulge relevant information otherwise confidential information to AHSD notwithstanding that it might
otherwise be confidential. I hereby release all of those subordinates, employers, references, organizations, academic institutions,
and Alcester-Hudson School board from any and all liability arising from their giving or receiving information about my criminal
history, employment history, my academic credentials or qualifications, and my suitability for employment with Alcester-Hudson
School District.
I understand and agree that, if hired, my employment is for no definitive period and, regardless of the date of payment of my
wages or salary, may be terminated at any time without any prior notice; except where specific contract terms or otherwise by
applicable law or board policy dictates dismissal shall be with or without cause.
I further understand that only the President or another person specifically designated by the President has the authority to create
or enter into any employment agreement on behalf of Alcester-Hudson School District.
In consideration of my employment, if hired, I agree to comply with all rules, procedures, and regulations set forth by the School
Board of the school. The School Board and the President reserve the right to change these rules, policies, and procedures at any
time. I furthermore understand consideration of this application and the continuation of this application of any subsequent
employment depends upon the truth and accuracy of this information.
NONDISCRIMINATION POLICY
Alcester-Hudson District #61-1 does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs and activities and provides equal access to
designated youth groups. The following person has been designated to handle inquiries regarding the non-discrimination policies:
504 Coordinator
Lynette Busch
PO Box 198
Alcester, SD 57001
605-934-1890
Title IX Coordinator
LeeAnn Haisch
PO Box 198
Alcester, SD 57001
605-934-1890
Telephone: 816-268-0550
FAX: 816-268-0599; TDD: 800-877-8339
Email: [email protected]