________________________________________________________________________________________
Legal Information
Are you eligible to work in the United States? Yes No
Have you ever been convicted of a felony? Yes No
If so, identify __________________________________________________________________________
Have you ever been discharged from a position? Yes No
If so, identify __________________________________________________________________________
Are you currently a party to a pending lawsuit or administrative action? Yes No
If so, identify __________________________________________________________________________
Veterans’ Preference
Check this box if you wish to claim veterans’ preference. To receive veteran’s preference, you must
meet the requirements of state law and you must attach your DD214 (separation papers). State law requires
residency in South Dakota to be eligible for veterans’ preference.
Place of residency if dierent from mailing address:
Address City State ZIP Code
The Sioux Falls School District is an equal opportunity employer providing opportunities for employment without regard
to race, color, creed, religion, age, gender, disability, national origin or ancestry. Inquiries concerning the application of
Title IX, Section 504 or Title VI, or the Americans with Disabilities Act of 1992 may be referred to the Assistant
Superintendent-Human Resources/Administrative Services at 201 East 38th Street, Sioux Falls, SD 57105-5898,
(PH: 605-367-7816, TDD: 605-367-7948), or to the U.S. Department of Education, Oce for Civil Rights, 10220 North
Executive Hills Blvd., Kansas City, MO 64153-1367, (PH: 816-880-4202; TDD: 816-891-0582; FAX: 816-891-0644).
Authorization
I authorize the Sioux Falls School District to make any investigation of any personal, educational,
vocational, or employment history. I further authorize any current or former employer, person, firm,
corporation, educational or vocational institution or government agency to provide the Sioux Falls
School District with information they have regarding me. I hereby release and discharge the Sioux Falls
School District and those who provide information from any and all liability as a result of furnishing and
receiving this information. I further agree that falsification of any part of this application, including any
accompanying inserts, shall be sucient cause for dismissal. References and personal information which
become a part of this application will be regarded as confidential and shall not be revealed to me.
Further, I understand the Sioux Falls School District is drug free/smoke free/tobacco free and that any
oer of employment is conditional based upon a completed criminal background check.
Signature ___________________________________________________ Date ____________________
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Updated: July 30, 2020