APPLICATION for SUPPORT PERSONNEL

Return to:
GRAND COUNTY SCHOOL DISTRICT
264 South 400 East
Moab UT 84532

Date: Social Security Number:
Name (Last / First / Middle):
Address (Street / City / State / Zip)
Home Phone: Work Phone:
Date of Birth (Optional): Place of Birth (Optional):
Dates of Military Service From: (Month / Day / Year) To: (Month / Day / Year)
Position(s) for which you would like to apply:
List any trade or professional licenses, certificates or registrations.
Have you ever been convicted of a felony?
YES
NO
 If yes, please explain:
REFERENCES - Please list three (3) persons not related to you whom you have known at least one year.
Name
Address
Telephone Number
     
     
     
EDUCATION High School Graduate?
YES
NO - Please circle highest grade completed 1 2 3 4 5 6 7 8 9 10 11 12
GED or Equivalent? YES
NO
College, Business or Trade Schools Attended
Name and City Location
Major or Vocational Subjects
Length of Time Attended
Date
Completed
Degree
         
         
         
WORK HISTORY - Beginning with present or most recent, list your three most significant employers. Include military service if applicable.
Firm Name: Dates From: To:
Address: Phone:
Job Title and Duties:
Reason for Leaving:
Firm Name: Dates From: To:
Address: Phone:
Job Title and Duties:
Reason for Leaving:
Firm Name: Dates From: To:
Address: Phone:
Job Title and Duties:
Reason for Leaving:

ADDITIONAL INFORMATION - Machines, Equipment, Tools Used, Related Activities, etc.

CERTIFICATION OF APPLICANT
I certify that all statements made in this application are true and correct, and that any misstatement of material facts may subject me to disqualification or dismissal. Also, I authorize investigation of all statements made in this application.

Signature: _____________________________________________________________________________________

Date: