Join Our Team of Coaches!

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Position Applying For *

Date available *

Do you have experience in coaching or leading this activity? Please give examples/explanation. *

Please check any areas in which you have certifications or specialized training *

Are you legally authorized to work in the United States? *

Yes

No

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

YES

NO

Have you ever been convicted of a felony? *

YES

NO

If yes, please explain.

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?

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?
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.