Fillable Date of Reapplication

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Date of Reapplication

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Date of Application Position(s):
Date of Reapplication
Name
Address
State Zip
Have you ever been employed in a KPERS or KP&F covered position? Yes No
Are you currently receiving retirement benefits from KPERS or KP&F? Yes No
Have you ever been employed by USD 470 (Arkansas City Public Schools)?
Yes No
If yes, when?
EDUCATION:
WORK EXPERIENCES: Please list the jobs you have held. List most recent one in the first space, the next one in the
second, etc.
Name of Firm or City and Date Date Reason for
Organization State Started Left Leaving
Please list any special work skills:
Last
First
Under what name?
Name of School
Location
Specialized Training Received
College
Middle
EMPLOYMENT APPLICATION
CLASSIFIED STAFF
Unified School District 470
2545 Greenway
Phone Number
Arkansas City, KS 67005
Street
City
High School
Other
REFERENCES: Give names and addresses of two or more references who can attest to your character and job skills (such as
a former employer, teacher, etc.)
If yes, who?
This application will be kept on active file for a period of three (3) months. It will then be placed in an inactive file for a
period of six (6) months. If you desire to keep this application active after the three (3) month period, you must notify USD 470.
USD 470 is an equal opportunity employer and selects the best matched individual for the job based upon job related qualifications,
regardless of color, race, creed, sex, national origin, age, handicap or other protected groups under state, federal or local Equal
Opportunity laws.
2. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning
3. I authorize you to request, receive and verify all information given on this application and I release you from all damages that
4. I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete
5. Although USD 470 makes every effort to accommodate individual preferences, school needs may at times make the following
I further understand that this is an application for employment and that no employment contract is being offered.
I understand that if I am employed, such employment is for no definite period of time and that USD 470 can change wages, benefits
and conditions at any time.
I have read and understand the above. Also, I understand that if I become employed by USD 470, as part of my employment
processing, I will be required to furnish the following: official social security card and driver's license. A "Certification of
Health for School Personnel" form will be required before employment is complete.
Address
Phone
Name
Address
Phone
Date
Signature
1. I certify that all the information provided by me in this application is true and complete. I understand that any misstatement,
falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination.
my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application,
and I release all such parties from all liability for any damages that may result from furnishing such information to you. I authorize any background
checks by any third party.
result from your doing so. I authorize any physician or hospital to release any information which may be necessary to determine my ability to
perform the duties of a job I am being considered for prior to employment or in the future during my employment with USD 470.
such investigation and I release you from all liability for any damages that may result from your doing so.
Name
Address
Phone
conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and
accept these as conditions of my continuing employment.
Name
All contacts directed to: Linda Postelwait, Personnel Clerk
USD 470 2545 Greenway P.O. Box 1028
Arkansas City, KS 67005 620-441-2000
linda.postelwait@usd470.com
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Date of Reapplication

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Completed 21 December 2021

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