Clear Creek Amana Community School District
EMPLOYMENT APPLICATION
Position Desired
Date
Name
Telephone (Home)
(Last)
(First)
(Middle)
Telephone (Cell)
Mailing Address
(Street)
(PO Box)
(City)
(State)
(Zip)
Email Address __________________
LICENSE DOCUMENTATION FOR TEACHER APPLICANTS ONLY
Iowa Department of Education License/Certificate Folder Number
Type of License in Force
Date Issued
Expiration Date
Endorsements
ALL APPLICANTS: Education & Background
Highest Degree Held
Granted by
Date
Address of Institution
Latest Date of College Credit Earned
Institution
List all training and/or experience relevant to this position:
Do you posses a release from your current employer:
Yes
No
N
o
Yes
No Y
e
N/A s
N/A
Are you related to anyone currently employed at Clear Creek Amana School District?
Yes
N
/A N/
No
If yes, name the employee
Define relationship
Marriage
Family
Other
The Clear Creek Amana School District does not prohibit the hiring of related persons but does require the
relationship status for supervision issues.
Have you served in the military?
Yes
No
Dates of Services
Type of Discharge
Are you prevented from lawfully becoming employed in this country due to Visa or Immigration Status?
Do you object to driving or traveling if required by your job duties?
Yes
No
Clear Creek Amana Community School District © 2013
Yes
No
List schools attended (most recent first):
City/State
Dates Attended
Graduation
Yes/No/Date
Diploma, Certificate,
Degree Earned
Employer
City/State
Position
Phone
Dates From/To
Reason for leaving
WORK
EXPERIENCE
EDUCATION
School
Employer
Relationship to applicant
Daytime Phone
EMPLOYMENT
REFERENCES
Name
Moral turpitude is an act of baseness, vileness, or depravity in the private and social duties which a person owes another member of society or
society in general and which is contrary to the accepted rule of right and duty between persons, including but not limited to theft, attempted theft,
murder, rape, swindling, and indecency with a minor. Have you ever been convicted of a felony or any offense involving moral turpitude?
Yes
No
Explain
Misrepresentation or willful omission may be sufficient cause for disqualification of this application or termination of employment. I hereby
authorize the Clear Creek Amana School District to conduct work history and personal reference, inquiries to determine my acceptability for
employment.
Return to:
Signature*
* The candidate’s typed name may be submitted electronically in
lieu of signature
Clear Creek Amana Community School District
327 S. Augusta Avenue
PO Box 487
Oxford, Iowa 52322
email: humanresource@ccaschools.org
The Clear Creek Amana School District does not discriminate based on race, color, national origin, sex, disability, age, religion, creed, sexual
orientation or gender identity. Direct inquiries to: Director of the Region VII, Office for Civil Rights, Citigroup Center, 500 W Madison St, Suite
1475, Chicago, IL 60661 (312) 730-1560, email: OCR.Chicago@ed.gov or the Iowa Civil Rights Commission, 400 E. 14th St, Des Moines, Iowa
50319-1004, (515) 281-4121 or 1-800-457-4416, http;://www.state.ia.us/government/crc/index.html. This inquiry or complaint to the federal
office may be done instead of, or in addition to, an inquiry or complaint at the local level.
Clear Creek Amana Community School District © 2013