PHONE NUMBER POSITION TITLE DATES OF EMPLOYMENT PHONE NUMBER POSITION TITLE DATES OF EMPLOYMENT PHONE NUMBER

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2 NAME (Last, First, Middle) APPLICATION FOR EMPLOYMENT (Mechanic) LIBERTY SCHOOL DISTRICT #362 TRANSPORTATION DEPARTMENT S. North Pine Creek Road, Spangle, WA Transportation Department Phone: District Office Phone: District FAX: PHONE Home: ( ) Mobile: ( ) ADDRESS DRIVER S LICENSE NUMBER ENDORSEMENTS (If any) EMERGENCY CONTACT (Name, Phone Number(s) ) US CITIZEN? Yes No If NO, provide Visa number and expiration: EMPLOYMENT HISTORY IF NOT CURRENTLY EMPLOYED, CHECK APPROPRIATE BOX Never Employed Self-employed Previously Employed: CURRENT EMPLOYER to Full-time Part-time HIRE DATE WORK HOURS POSITION TITLE SUPERVISOR S NAME PHONE NUMBER OK to contact as a reference? Yes No PREVIOUS EMPLOYER POSITION TITLE DATES OF EMPLOYMENT SUPERVISOR S NAME PHONE NUMBER OK to contact as a reference? Yes No PREVIOUS EMPLOYER POSITION TITLE DATES OF EMPLOYMENT SUPERVISOR S NAME PHONE NUMBER OK to contact as a reference? Yes No LIBERTY SCHOOL DISTRICT IS AN AFFIRMATIVE ACTION EMPLOYER

3 RELATED EXPERIENCE & DRIVING HISTORY DRIVING EXPERIENCE, BY VEHICLE LIBERTY SCHOOL DISTRICT #362 TRANSPORTATION DEPARTMENT APPLICATION FOR EMPLOYMENT (MECHANIC) PAGE 2 OF 4 VEHICLE TYPE YEARS VEHICLE TYPE YEARS VEHICLE TYPE YEARS Bus Farm Vehicle Private Automobile Truck Delivery Van Other: YOU WILL BE ASKED TO FURNISH PROOF OF YOUR DRIVING RECORD How many traffic citations have you received in the last three years? Have you ever received a citation for any of the following: Drunk driving... Yes No Reckless driving... Yes No Negligent driving... Yes No Hit & run driving... Yes No EDUCATION HIGH SCHOOL (Name, City, State) GRADUATION DATE BUSINESS OR TECHNICAL SCHOOL DATES ATTENDED DEGREE/CERTIFICATE AWARDED UNDERGRADUATE COLLEGE DATES ATTENDED DEGREE, MAJOR GRADUATE SCHOOL DATES ATTENDED REFERENCES DEGREE, MAJOR LIST TWO PERSONAL REFERENCES AND ONE EMPLOYMENT REFERENCE (Do not list family members.) PERSONAL REFERENCE (Name, Address, Phone Number) PERSONAL REFERENCE (Name, Address, Phone Number) EMPLOYMENT REFERENCE (Name, Address, Phone Number) LIBERTY SCHOOL DISTRICT #362 IS AN EQUAL OPPORTUNITY EMPLOYER Liberty School District does not discriminate on the basis of sex, race, religion, creed, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained guide dog or service animal in its programs, employment, and/or activities. The district will provide equal access to school facilities to the Boy Scouts of America and all other designated youth groups. District programs will be free of sexual harassment. The following employees have been designated to handle inquiries regarding the nondiscrimination policies: Kyle Rydell, Civil Rights Compliance Coordinator, S. North Pine Creek Rd., Spangle WA 99031, (509) ext. 2213, krydell@libertysd.us; Blaze Burnham, Title IX Coordinator, 6404 E. Spangle-Waverly Rd., Spangle WA 99031, (509) ext. 1221, bburnham@libertysd.us; Cyndi Freeman, Section 504 Coordinator, S. North Pine Creek Rd., Spangle WA 99031, (509) ext. 2217, cfreeman@libertysd.us. Signature: Date:

4 LIBERTY SCHOOL DISTRICT #362 TRANSPORTATION DEPARTMENT APPLICATION FOR EMPLOYMENT (MECHANIC) PAGE 3 OF 4 Please answer the following pre-interview questions as part of the Application for Employment: 1. Why do you want to work at Liberty School District? 2. How do you develop trust and mutual understanding with your coworkers? 3. Your supervisor tells you to change something you believe was done right. What would you do? 4. How do you prioritize important jobs? 5. Describe any experience you have driving trucks, buses or other larger vehicles. What is your comfort level driving large vehicles?

5 LIBERTY SCHOOL DISTRICT #362 TRANSPORTATION DEPARTMENT APPLICATION FOR EMPLOYMENT (MECHANIC) PAGE 4 OF 4 LIBERTY SCHOOL DISTRICT #362 APPLICANT DISCLOSURE FORM PURSUANT TO RCW In accordance with RCW , applicants and prospective volunteers are required to complete this disclosure form. In addition, applicants who have been offered employment or volunteer assignments as outlined in said law, will be required to complete a WSP/FBI criminal background check. Applicants may be employed on a conditional basis pending completion of such background investigation. Volunteers will be retained on the same conditional basis. Answer yes or no to each of the listed items. If the answer is yes to any item, explain in the area provided, indicating the charge or finding, the date, and the court(s) involved. 1. Have you ever been convicted of any crimes against persons as defined in RCW and listed as follows: aggravated murder, first, second, or third degree murder; first or second degree kidnapping; first, second, or third degree assault; first, second, or third degree rape; first, second, or third degree statutory rape; first or second degree robbery; first degree arson; first degree burglary; first or second degree manslaughter; first or second degree extortion; indecent liberties; incest; vehicular homicide; first degree promoting prostitution; communication with a minor; unlawful imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment; child abuse or neglect as defined in RCW ; first or second degree custodial interference; malicious harassment; first, second, or third degree child molestation; first or second degree sexual misconduct with a minor; patronizing a juvenile prostitute; child abandonment; promoting pornography; selling or distributing erotic material to a minor; custodial assault; violation of child abuse restraining order; child buying or selling; prostitution; felony indecent exposure; or any of these crimes as they may be renamed in the future? 2. Have you even been found in any dependency action under RCW (2)(b) to have sexually assaulted or exploited any minor or to have physically abused any minor? 3. Have you ever been found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor? 4. Have you ever been found in any disciplinary board final decision to have sexually abused or exploited any minor or to have physically abused any minor? 5. Have you been convicted in the past 10 years of any crime: felony or misdemeanor? If yes, cite and describe each incident on a separate piece of paper. SIGNATURE RELEASE All of the information I have provided in this application is true, correct, and complete. I authorize Liberty School District to inquire with former employers or references and obtain any and all information regarding my job-related background. I release and waive Liberty School District #362, my former employer, and all references from any and all liability in obtaining or disclosing such information. I agree that if I have provided false or incomplete statements, the district may, at its sole discretion, without notice or due process procedure, terminate my employment contract. If such action is taken by the district, the contract shall be deemed void from its inception. Signature of Applicant Date

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