Fillable COLUMBIA BOROUGH SCHOOL DISTRICT (City of Oakland)

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COLUMBIA BOROUGH SCHOOL DISTRICT (City of Oakland)

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1
COLUMBIA BOROUGH SCHOOL DISTRICT
200 North Fifth Street, Columbia, PA 17512
Phone: 717-684-2283 • Fax: 717-681-2617
Employment Application
Applicant Information
Full Name: Date:
Last First M.I.
Address:
Street Address Apartment/Unit #
City State ZIP Code
Phone: Email
Date Available: Desired Salary:
YES NO NO
If no, are you authorized to work in the U.S.?
YES
Position Applied for:
Are you a citizen of the United States?
Have you ever worked for Columbia
Borough School District?
YES NO
If yes, when?
Education
High School:
YES NO
From: To:
Address:
Did you graduate?
Trade or
Business
School:
YES NO
From: To: Degree:
College:
YES NO
From: To:
Address:
Did you
graduate?
Address:
Did you graduate?
Degree:
Other: Address:
YES NO
From: To: Did you graduate? Degree:
-Select-
2
Relationship:
Phone:
References
Please list three professional references.
Full Name:
Company:
Address:
Full Name:
Company:
Address:
Phone:
Relationship:
Full Name:
Company:
Address:
Phone:
Relationship:
Previous Employment
Company:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Reason for Leaving:
Responsibilities:
From: To:
May we c
ontact your previous supervisor for a reference?
YES NO
Company:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Reason for Leaving:
Responsibilities:
From: To:
May
we contact your previous supervisor for a reference?
YES NO
Company:
Address:
Supervisor:
Phone:
Phone:
Phone:
1
Job Title: Starting Salary: Ending Salary:
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
Disclaimer and Signature
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.
Signature: Date:
“An Equal Opportunity Employer”
Columbia Borough School District is an Equal Opportunity Employer. The District’s personnel policy is aimed at insuring
equal treatment to all individuals with regard to employment, rates of pay and all other terms and conditions of
employment regardless of race, religion, color, national origin, sex, age, disability, handicap or because a person is a
disabled veteran or veteran of the Vietnam War era. This policy of nondiscrimination extends to any protected
classifications. Inquiries should be directed to the Superintendent, Section 504 and Title IX Coordinator, ADA
Coordinator, Columbia Borough School District, 200 N Fifth Street, Columbia, PA 17512
Please let us know if you require accommodation of a disability to participate in the application process.
If you have any questions please email Human Resources at hr@columbiabsd.org .
By typing your name above, you are agreeing that this is your signature and all information
stated above is true to the best of your knowledge.
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COLUMBIA BOROUGH SCHOOL DISTRICT (City of Oakland)

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Completed 30 September 2021

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