APPLICATION FOR EMPLOYMENT
The Solon Springs School District does not discriminate in employment on the basis of race, color, religion, national origin, sex, age,
marital status, disability, sexual orientation, arrest or conviction record, or any other legally protected status. The District is committed to providing
access, and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities.
PERSONAL INFORMATION:
Date: ___________________________ Social Security Number: __________________________________
Name: ___________________________________________________________________________________________________
Last First Middle
Present Address __________________________________________________________________________________________
Street City State/Zip
Permanent Address __________________________________________________________________________________________
Street City State/Zip
Telephone (Home): __________________________ Cell Phone: ____________________________________________
(Work): __________________________ E-Mail: ____________________________________________
POSITION SOUGHT: (check all that apply)
Teacher Teacher Aide Substitute Teacher Bus Drive/Sub
Secretary/Clerical Kitchen Help/Cook Janitorial Coach
EDUCATIONAL HISTORY:
High School:
Name: ____________________________ Location: ___________________________ Diploma (Y/N) ______________
Post Secondary (most recent first)
School: ____________________________ Location: ___________________________ Diploma (Y/N) ______________
Major: ____________________________ Minor: ___________________________
School: ____________________________ Location: ___________________________ Diploma (Y/N) ______________
Major: ____________________________ Minor: ___________________________
Teacher Certificationi (if applicable) Area(s): ___________________________ Grades: ______________
Revised 3/2019 1
Additional relevant schooling & certification information should be included on separate sheet of paper.
STUDENT TEACHING: (for teacher applicants only)
School Name:________________________ Location: ___________________________ Grade (s) ______________
Coop Teacher: _______________________ Phone: ___________________________
School Name:________________________ Location: ___________________________ Grade (s) ______________
Coop Teacher: _______________________ Phone: ___________________________
WORK EXPERIENCE: (most recent first – attach separate sheet with listing of other relevant employment)
Position: __________________________________________ Employer: __________________________________________
Address: _________________________________________________________ Supervisor: __________________________
Reason for Leaving: ____________________________________________ Dates of Employment: _____________________
Position: __________________________________________ Employer: __________________________________________
Address: _________________________________________________________ Supervisor: __________________________
Reason for Leaving: ____________________________________________ Dates of Employment: _____________________
Position: __________________________________________ Employer: __________________________________________
Address: _________________________________________________________ Supervisor: __________________________
Reason for Leaving: ____________________________________________ Dates of Employment: _____________________
REFERENCES:
Name: _________________________________ School/Company:___________________ Phone: ___________________
Position: _______________________________________ Address: ______________________________________________
Basis of Reference (e.g. previous supervisor): ____________________________________________________________________
Name: _________________________________ School/Company:___________________ Phone: ___________________
Position: _______________________________________ Address: ______________________________________________
Basis of Reference (e.g. previous supervisor): ____________________________________________________________________
Name: _________________________________ School/Company:___________________ Phone: ___________________
Position: _______________________________________ Address: ______________________________________________
Basis of Reference (e.g. previous supervisor): ____________________________________________________________________
Revised 3/2019 2
BACKGROUND INFORMATION:
Are you currently employed? ______ Yes ______ No
Is your current employer aware of your application for another job? ______ Yes ______ No ______ N/A
Have you ever been investigated, disciplined, dismissed,
asked to resign, or resigned from employment based in whole, or in
part, because of job-related performance factors OR immoral conduct? ______ Yes ______ No
If “Yes”, please provide written explanation:
_______________________________________________________________________________________________________
Have you ever been convicted of a felony, misdemeanor or
traffic related offense beyond a minor speeding ticket? ______ Yes ______ No
If “Yes”, please provide written explanation:
_______________________________________________________________________________________________________
(Payment of a fine will not be an automatic bar to employment and will be considered only as it is related to employment)
Have you ever paid a civil forfeiture, or fine for a non-traffic related
offense, including municipal court violations, shoplifting, etc.? ______ Yes ______ No
If “Yes”, please provide written explanation:
_______________________________________________________________________________________________________
(Payment of a fine will not be an automatic bar to employment and will be considered only as it is related to employment)
Do you have any charge(s) pending against you? Have you ever had a ______ Yes ______ No
Restraining Order against you? If “Yes”, please provide written explanation:
_______________________________________________________________________________________________________
(A pending charge will not be an automatic bar to employment and will be considered only as it is related to employment)
Have you ever been denied employment because of failure to
pass a drug screening OR for falsification of employment records? ______ Yes ______ No
If “Yes”, please provide written explanation:
_______________________________________________________________________________________________________
An offer of employment is conditional based upon proof of eligibility to work in this country, successful background & criminal background checks,
appropriate certification, passing of physical and other conditions that may be required including approval by the School Board, including favora-
ble drug screening by a clinic selected by the District.
AUTHORIZATION
I hereby authorize investigation of all statements contained in this application or made by me during the hiring process. I understand that misrep-
resentation or omission of facts called for is cause for denial of employment or dismissal. The Solon Springs School District and its employees shall
not be held liable if I am denied employment, or terminated following employment, if it is verified that I provided false statements and/or omitted
substantive information.
I voluntarily grant the Solon Springs School District the right to investigate statements I have made in the job application process, as well as other
job related information, activities and references. I also authorize any current or former employer, person, firm, corporation, school, or govern-
ment agencies (including law enforcement) to disclose to the Solon Springs School District any information that is sought as part of a background
check. I hereby release the School District of Solon Springs, and providers of information, from liability for any damages, which may result from
furnishing of this information.
Dated: _______________________________ Applicant’s Signature: ____________________________________________
Revised 3/2019 3
PERSONAL STATEMENT:
You have applied for a position in a school district that is very unique because of its size, demographics and location. How would you
contribute to this being one of the best small school districts in Wisconsin?
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Solon Springs Vision:
“We are an inviting, caring, family environment partnering with our communities
to engage ourselves in the learning process and challenge students with pride and honor.”
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Certified staff who are hired must present copies of licenses held, or license application(s) in process, within 10 days of employment
or by September 15th of one’s first year of employment.
Revised 3/2019 4
