Our District: Job Applications

Food Service Personnel Application

by Kris Van Pelt

October 11, 2005

401.4 �Exhibit G

BOARD OF DIRECTORS

OGDEN COMMUNITY SCHOOL DISTRICT

FOOD SERVICE PERSONNEL 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. Experience in preparing large quantities of food.

___ __ 2. Trained in First Aid? Training______________________

___ __ 3. Trained in CPR? Training________________________

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_______________________

Location of Duty________________Rank at Discharge___________________

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.