Our District: Job Applications

Custodian Application

by Kris Van Pelt

January 20, 2005

401.4 - Exhibit F

BOARD OF DIRECTORS

OGDEN COMMUNITY SCHOOL DISTRICT

CUSTODIAN APPLICATION FORM

Please complete all information and forward to:

Superintendent

Ogden Community School District

PO Box 250

Ogden, IA 50212

Personal Information

Last Name______________________First_____________________ Middle______________

Business Address_________________________________________Telephone_____________

City ________________________________State _____________________ Zip ____________

Home Address___________________________________________ Telephone_____________

City_________________________________State ______________________Zip____________

Present Position________________________________________________________________

Present Employer__________________________________________Telephone ____________

Are you capable of the following:

Yes No

___ ___ 1. Trained in first aid. Training ________________________________________

___ ___ 2. Trained in CPR. Training__________________________________________

___ ___ 3. Electrical, Maintenance & Installation________________________________

(are you willing to be trained______________________)

___ ___ 4. Plumbing, Maintenance & Installation_________________________________

(are you willing to be trained _____________________)

___ ___ 5.Carpentry Skills__________________________________________________

(are you willing to be trained______________________)

___ ___ 6. Steam or hot water boiler operation__________________________________

(are you willing to be trained _____________________)

Were you honorably discharged from the United States military forces after service between the periods of December 7, 1941 and December 31, 1946, or June 25, 1950 to January 31, 1955, or August 5, 1964 to May 7, 1975, or during the Persian Gulf conflict? _________Yes ________No

Please complete if you are claiming a veteran's preference:

Active Duty/Reserve Duty

Branch_______________________Period of Duty_______________________

Has there ever been a judicial or administrative finding that you have abused or mistreated a minor or child? (If yes, attach explanation.) ____________Yes ____________No

Employment History

List all experience in chronological order.

Name Location Position From/to Supervisor Phone

_____________________________________________________________________________

References (list at least two)

Name Position Res. Phone Bus. Phone

____________________________________________________________________________

I certify that the information given in this application (and accompanying resume, if any,) is true

and complete to the best of my knowledge. I authorize investigation of all statements contained

in this application, and I authorize Ogden Community School District to contact my references

and prior employers, and release from all liability or responsibility all persons or corporations

requesting or supplying information. I understand that giving false, incomplete, or misleading

information in my application or interview may result in withdrawal of my application for consideration or in discharge.

I understand that the Ogden Community School District will do a criminal records and child abuse check on me.

I UNDERSTAND THAT I MAY NOT BE EMPLOYED UNTIL APPROVAL IS GIVEN BY THE DISTRICT�S BOARD OF DIRECTORS.

Signed_______________________________________________Date_____________________

The Ogden Community School District provides equal employment opportunities to all persons regardless of race, color, national origin, creed, religion, martial status, parental status, age or

disability. Questions regarding compliance with equal employment opportunities should be directed to the Superintendent at Box 250, Ogden, IA 50212, telephone number (515) 275-2894.