Employment

20%

Name*
First Middle Last
Date*
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Business/Message Phone
Position Applying For*
Hours*
- Full Time
- Part Time
Have you previously applied for or been employed with GSD?*
- Yes
- No
Position(s)*
Start Date*
End Date*
Date of Birth*
Social Security Number*
If you are under 18, can you furnish a work permit?
- Yes
- No
Are you legally eligible for employment in the U.S.?*
(Proof of U.S. citizenship or immigration status will be required upon employment)
- Yes
- No
Driver's License Number
Have you ever used another name other than what is listed above?*
- Yes
- No
What name?*
In the space provided, please list each address you have redsided since age 18:
Address From To

Beginning with your current or most current job, list all paid or unpaid work experience during the last ten years (or longer if pertinent to the positions applied for) including military experience. Explain any gaps in your work experience that exceed six months.
Employer Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Position or Title
Supervisor
Start
End
Reason for Leaving
May we contact this employer for a work reference
- Yes
- No
Please explain
Employer Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Position or Title
Supervisor
Start
End
Reason for Leaving
May we contact this employer for a work reference
- Yes
- No
Please explain
Employer Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Position or Title
Supervisor
Start
End
Reason for Leaving
May we contact this employer for a work reference
- Yes
- No
Please explain
Indicate certificates, training and/or skills which are applicable to the position your desire.

I understand that before I can be hired and begin work, I must take and successfully pass a pre-employment DRUG SCREENING, administered by a physician designated by the District. I hereby authorize the release of all prior medical records to the physician pertaining to my employment. I also authorize the release of all my prior employment information to the bearer of this release.

I give the District the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability the District and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
Signature of Applicant*
Date*
Comments
This field is for validation purposes and should be left unchanged.