Date Received________________

Lavaca Public Schools

P.O. Box 8

Lavaca, Arkansas 72941

Application for Classified Positions

Position applying for: __________________________________

Last Name: _____________________________

First Name: _____________________________

Middle Name: ___________________________

Social Security Number: ___________________

Phone Number (Primary):__________________

Phone Number (Secondary):________________

Address: __________________________________________________________

E-mail Address: ____________________________________________________

Have you previously been employed by Lavaca Public Schools? Yes____   No____

            If yes, when and in what position?:_________________________________

Date available for employment:__________________

Are you a citizen of the U.S.? Yes____   No____

Have you ever been convicted of a felony? Yes____   No____

Have you ever been released or asked to resign? Yes____   No____

            If yes, please explain________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Are you presently employed? Yes____  No____

If yes, where and in what position? ___________________________________

            Why do you wish to leave? _________________________________________

Education

Institution

Dates Attended

Area of Study

Please list any special training, skills, or certification:__________________________

_____________________________________________________________________

_____________________________________________________________________

Experience

Please list work history.

Institution

City, State

Position

Date

Reason for Leaving

Professional/Personal References

Please list 5 references including those from previous work history.

Name

Position

Address

Phone Number

Years Known

Why would you like to work for Lavaca Public Schools?________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

In order to be considered, this application must be signed and dated.

Signed: ___________________________________________________

Date: _____________________