Our District: Job Applications

Custodian Application

by Kris Van Pelt

September 08, 2006

Code No. 401.4Exhibit F

BOARD OF DIRECTORS

OGDEN COMMUNITY SCHOOL DISTRICT

CUSTODIAN APPLICATION FORM

Please complete all information and forward to:

Superintendent

Ogden Community School District

Box 250

Ogden, Iowa 50212

PERSONAL INFORMATION

Last Name________________________First________________ Middle______________________

Business Address_________________________________________Telephone_________________

City________________________________State______________Zip_____ Email______________

Home Address___________________________________________Telephone_________________

City________________________________State______________Zip______ Email_____________

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. Training___________________________

_____ ______ 4. Plumbing, Maintenance & Installation. Training____________________________

_____ ______ 5. Carpentry Skills. Training_____________________________________________

_____ ______ 6. Steam or hot water boiler operation. Training_____________________________

Were you honorably discharged from the United States military forces? ________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.

Code No. 401.4-Exhibit F-Page 2 of 2

EMPLOYMENT HISTORY

List all experience in chronological order.

NAME LOCATION POSITION FROM/TO SUPERVISOR PHONE

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________

PROFESSIONAL PREPARATION

INSTITUTION LOCATION MAJOR/MINOR DEGREE

________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________

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 authorize the Ogden Community School District to do a criminal records, sexual offender, and child abuse check on me.

If my duties will include driving a school vehicle for which I need a CDL license and if the vehicle transports 16 or more persons or the vehicle weights 26,001 pounds or more, I have been informed of the requirement to submit to a drug test prior to being employed by the District to perform a safety-sensitive function. I consent to submit to the District's drug and alcohol testing program. I also understand that if I have a positive drug test, I will not be considered further for employment by the District.

Signed________________________________________________Date____________________

The Ogden Community School District provides equal employment opportunities to all persons regardless of race, color, national origin, creed, religion, gender, marital status, age or disability. Questions regarding compliance with equal employment opportunities should be directed to the Superintendent at Box 250, Ogden, Iowa 50212, telephone number (515) 275-2894.