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Sioux Valley School District 5-5
Street Address Street Address
Street Address Hansina Ave
Volga SD Street Address
APPLICATION FOR EMPLOYMENT
Prospective employees will receive consideration without discrimination
because of race, creed, color, sex, age, national origin or disability.
PERSONAL
Last name First Middle
Date
Street Address
Home Phone
City, State, Zip
Business Phone
Have you ever applied for employment with us?
Yes No If yes: month and year
Position Desired
How did you learn of our opening?
Males born after December 31, 1959, are required to register for Selective
Service. Are you registered? __Yes __No If yes: Selective Service
number: (If you do not know your Selective
Service number, you can obtain it by calling PHONE NUMBER AVAILABLE)
EDUCATION
Course # of Years
Did you
School Name & Location of School of Study
Completed Graduate Degree
College
College
College
College
College
High School
Grade School
Other
Teaching or Administrative Certificate (i.e.: elementary, middle school,
junior high, secondary):
EMPLOYMENT
Please give accurate, complete full-time and part-time employment record.
Start with present or most recent employer.
1. Name
Telephone
( )
-
Address
Employed (Month/Year)
From
To
Name and Title of Supervisor
State Job Title & Describe Your Work
Reason for leaving
2. Name
Telephone
( )
-
Address
Employed (Month/Year)
From
To
Name and Title of Supervisor
State Job Title & Describe Your Work
Reason for Leaving
3. Name
Telephone
( )
-
Address
Employed (Month/Year)
From
To
Name and Title of Supervisor
State Job Title & Describe Your Work
Reason for Leaving
4. Name
Telephone
( )
-
Address
Employed (Month/Year)
From
To
Name and Title of Supervisor
State Job Title & Describe Your Work
Reason for Leaving
We may contact the employers listed above unless you indicate those you do
not want us to contact. Do not contact employer number(s) Reason
Check the extra-curricular activities you are qualified to supervise:
Sports Timer Athletic Director Football
Basketball
Wrestling Track Cross Country
Volleyball
Golf Pep Band/Pit Orchestra Oral Interp
Annual
Photography Junior Class Concessions
FCCLA
Vocal Music Pep Club/Cheerleader FFA
Drama
Give a brief statement as to why you would like to work at Sioux Valley
School.
The information provided in the Application for Employment is true,
correct, and complete. I understand that, if I am employed, any
misstatement or omission of fact on this application may result in my
dismissal.
Date Signature
All new employees shall be subject to a criminal background check.
The Sioux Valley School District 5-5 does not discriminate in its
employment policies and practices, or in its educational programs on the
basis of race, color, creed, religion, age, sex, disability, national
origin, or ancestry. Inquiries concerning the application of Title VI
,Title IX or 504 are to contact Supt. Laura Schuster at Sioux Valley
School, 200 Hansina Ave., Volga, SD 57071, phone PHONE NUMBER AVAILABLE or to the
U.S. Department of Education, Office for Civil Rights , 8930 Ward Parkway,
Suite 2037 , Kansas City, Missouri 64114. Phone : PHONE NUMBER AVAILABLE, FAX: 816-
823-1404, TDD: PHONE NUMBER AVAILABLE E-Mail: EMAIL AVAILABLE
<mailto:EMAIL AVAILABLE> Website: <http://www.ed.gov/ocr/>
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