Join Our Team of Classified Staff!

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Position Applying For *

Date available *

List any specific credentials, certifications, trainings, and licenses you currently hold. *

Are you a citizen of the US? *

Yes

No

If no, are you authorized to work in the US? *

Yes

No

Have you ever worked for the Washburn School District before? *

YES

NO

If yes, when?

Education

High School *

HS Address *

Dates attended *

Did you graduate? *

YES

NO

College

College Address

Dates attended

Did you graduate?

YES

NO

Degree

Other

Address

Dates attended

Did you graduate?

YES

NO

Degree

Employment History

Employer 1

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact?

Yes

No

Phone Number

Employer 2

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact?

Yes

No

Phone Number

Employer 3

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact?

Yes

No

Phone Number

References

Reference 1

Name *

Title *

Email Address *

Phone *

Reference 2

Name

Title

Email Address

Phone

Reference 3

Name

Title

Email Address

Phone

Military Service

Branch

Dates Served

Rank at Discharge

Type of Discharge

If other than honorable, explain

Additional Skills

List any additional skills that you would like to mention.

Why do you want to work at the Washburn School?

Job Skills and Training: Please complete all that apply to the position for which you are applying.

Business Manager:

	Explain in the spaces below...
How many years’ experience do you have in this area?	Explain in the spaces below...
What is your experience in managing the functions of purchasing, accounts payable, accounts receivable, and cash flow management with regards to expenditures?	Explain in the spaces below...
What have you done in your previous jobs that would relate to being a school business manager?	Explain in the spaces below...

CLERICAL/ADMINISTRATIVE ASSISTANT:

	Explain in the spaces below...
How many years’ experience do you have in this area?	Explain in the spaces below...
What clerical tasks have performed in the past?	Explain in the spaces below...
What computer skills do you have?	Explain in the spaces below...

CLASSROOM PARAPROFESSIONAL:

	Explain in the spaces below...
How many years’ experience do you have working with children other than your own?	Explain in the spaces below...
What kind of activities have you done with children other than your own?	Explain in the spaces below...
What age group(s) would you prefer to work with: Preschool, K-3, 4-6, or 7-12?	Explain in the spaces below...
What computer skills do you have?	Explain in the spaces below...

CUSTODIAL/MAINTENANCE:

	Explain in the spaces below...
How many years’ experience do you have as a custodian or maintenance worker?	Explain in the spaces below...
What type of custodial or maintenance work have you done?	Explain in the spaces below...
Describe the work you have done in maintaining floors and carpets.	Explain in the spaces below...
What types of power equipment have you used?	Explain in the spaces below...
What experience do you have in mowing, lawn maintenance, grounds care, or landscaping?	Explain in the spaces below...
What type of vehicle maintenance work can you perform?	Explain in the spaces below...

KITCHEN STAFF:

	Explain in the spaces below...
How manty years’ experience do you have in food service?	Explain in the spaces below...
Describe what you have done in preparing, serving, and managing as it relates to food service.	Explain in the spaces below...

BUS DRIVER:

	Explain in the spaces below...
How manty years’ experience do you have as a driver, either commercially or for a school?	Explain in the spaces below...
What type of license do you have, including restrictions and/or endorsements?	Explain in the spaces below...

Please Answer the Following Questions

Answer YES or NO to the following Questions *

Are you able to perform the essential functions of the position for which you are applying?
Are you presently employed?
In the answer to #2 is Yes, is your employer aware that you are seeking this position?
Have you ever been on an improvement plan or placed on probation?
Have you ever resigned or otherwise separated from any employment in order to avoid discharge?
Have you ever been dismissed, discharged, fired, or forced to resign from any employment?
Have you ever been disciplined by a past or present employer because of allegations of misconduct?
Are you presently charged with, but not convicted of, a crime? (Exclude civil infractions, such as minor traffic citations.)
Have you ever pleaded guilty or been convicted of any felony crime involving the physical injury or death of a child, promoting prostitution of a minor child; assault; incest; child abuse or neglect; custodial interference; child molestation; promoting pornography; selling or distributing erotic material to minors; criminal mistreatment; violation of a child abuse restraining order; or child abandonment? (The term "convicted" means all adverse dispositions, including a finding of guilty, a plea of guilty or nolo contendere, an Alford plea, a stipulation to the facts, a deferred or suspended sentence, or a deferred prosecution.)
Have you ever pleaded guilty to, or been convicted of one of the following crimes against persons: aggravated murder; first or second degree murder; first or second degree kidnapping; first, second, or third degree assault; rape or statutory rape; first or second degree arson; burglary, manslaughter or extortion; indecent liberties or indecent exposure; communication with a minor for immoral purposes; sexual exploitation of a minor or developmentally disabled person; been found by a court in a protection proceeding to have abused or financially exploited a vulnerable adult; criminal mistreatment; violation of a child abuse restraining order; or child abandonment?
Within the past seven (7) years, have you pleaded guilty to, been found guilty of, or forfeited bond regarding violation of any city or county ordinance or state law or regulation involving physical threat, injury or abuse of a victim who was then under the age of 18?
Have you ever been found in any dependency action under RCW 13.34.030(2)(b); been found guilty by a court in a domestic relations proceeding under Title 26RCW; or been found guilty in any disciplinary board final decision to have sexually assaulted or exploited any minor or to have physically abused any minor?
Have you ever pleaded guilty or been convicted of a misdemeanor or felony not listed above?

If you answered YES to any of the preceding questions, please provide an explanation or comment?

Disclaimer and Signature

People of disability may request reasonable accommodation in the hiring process by contacting the Superintendent; 713 7th St., PO Box 280; Washburn, ND 58577, or by calling (701) 462-3221.

The Washburn School District is an equal opportunity employer and subject to veteran’s preference laws. It also a drug-free, tobaccofree educational system. A criminal history background check is required prior to employment. The background check will be requested by the Washburn School District. The District employs only U.S. citizens and lawfully authorized non-U.S. citizens. All new employees must show employment eligibility verification as required by the U.S. Immigration and Naturalization Service.

I wish to be considered for employment with the Washburn School District and understand that my chances of obtaining such employment are reduced if they have incomplete information about me. I therefore authorize Washburn School District to check any references and to investigate any information provided in my application for employment as well as any other information related to my previous employers or other individuals who may have information about my work history, education, qualifications, or other matters relevant to my employability.
This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal references, professional references, and other appropriate sources. I waive my right of access to any such information, without limitation, and in consideration of the district’s review of this application, I hereby release the school district and the reference source from
any liability in connection with its release or use. This release includes previous employers, the sources listed above and specific examples as follows: the local North Dakota State Patrol, information from the Federal Bureau of Investigation of either data on all criminal convictions, or certification that no data on criminal convictions is maintained, information from the North Dakota State Department of Social Services Child Protective Services Unit and any locality to which they may refer, for release of information pertaining to any findings of child abuse or neglect investigations involving me. I agree to hold harmless from any liability, suit, claim, or other action any party of organization supplying such information to the Washburn School District. I also agree to hold harmless the Washburn School District and its employees, representatives, agents, and assigns from liability, suit, claim, or other action related to seeking such information. I am aware that copies of this form may be sent to former employers or other individuals who may have information about my employment history.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Print Name *

Date *

Signature *

clear

▪ This application may be submitted by mail, in person, or electronically. To submit by mail, send to Superintendent; Washburn Public School District; PO Box 280; Washburn, ND 58577. To submit electronically, email as an attachment to penny.hetletved@k12.nd.us or HIT SUBMIT on this form.
▪ You may include a cover letter and and a resume.

Please submit a cover letter

Please submit a copy of your resume.