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Oglala Lakota County School District
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Application for Employment
What School are you applying for?





Last Name:
First Name:
Middle Name:
Maiden Name:
Mailing Address:
Home Phone:
Cell Phone:
Work Phone:
eMail Address:
Educational Attainment:
If Masters Degree + or Bachelors Degree + is selected from the above question, please list hours attained.
South Dakota Teacher Certificate: Certificate Type:
South Dakota Teacher Certificate Expiration Date:
Are you a U.S. Citizen?
If no, are you eligible to work in the U.S.?
Month / Day / Year available for employment:
Have you ever been discharged or requested to resign from a position?
Have you ever had a driver’s license revoked or suspended?
Have you ever been convicted of criminal conduct?
Are any criminal charges or proceedings pending against you?
Have you ever been convicted of any offense involving the sexual molestation, physical or sexual abuse, or rape of a child or any felony?
Have you ever been convicted of a drug or alcohol related charge?
Have you ever been employed by the Oglala Lakota County School District?
If you answered "yes" to the above question have you ever been employed by the Oglala Lakota County School District, when?
1. Please list the most recent current or past employer and title. Include Military Experiences if applicable.
Employment Dates:
Position / Rank:
May we contact this employer?
Reason for Leaving:
Please provide a reference email of a person we may contact at your previous employment (no family members).
May we contact the references named above?
2. PREVIOUS EMPLOYER/S Please list a most recent past employer and title. Include Military Experiences if applicable.
Position / Rank:
Employment Dates:
Reason for Leaving:
May we Contact this employer?
Please provide a reference email of a person we may contact at your previous employment (no family members).
May we contact the references named above:
3. PREVIOUS EMPLOYER/S Please list the third most recent past employer and title. Include Military Experiences if applicable.
Employment Dates:
Position / Rank:
May we contact this employer?
Reason for Leaving:
Please provide a reference email of a person we may contact at your previous employment.
May we contact the references named above:
Please provide 3 professional references (no family members): Name, company, position, phone number, and email
Are you an honorably discharged military veteran?
If you were a military veteran, when were your dates of service?
How did you learn of the position you're applying for?
What position are you applying for?








































Your Name:
Your Email:

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Oglala Lakota County School District
206 School Street
Batesland SD, 57716
Phone: 605.288.1921 | Fax: 605.288.1814
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