Lincoln-Woodstock Cooperative School District SAU # 68

LINCOLN-WOODSTOCK COOPERATIVE
SCHOOL DISTRICT
SAU # 68
P.O. Box 846
Lincoln, NH 03251
APPLICATION
Date: ____________ Telephone: ____________________ Cell: ___________________
Name: __________________________________________________________________
Last First Middle
Social Security Number: _________________________ Date of Birth: ______________
Home Address: ___________________________________________________________

Street Town State Zip
Mailing Address: _________________________________________________________

Street Town State Zip
Email Address: ___________________________________________________________
Position Applying For: (Please Check)
______ Teacher/Specialist ______ Administrator ______ Substitute

______ Coach ______Custodian ______ Office Personnel
______ Aide ______ School Lunch ______ Other (specify)
================================================================
Education: Institution Major Minor Dates Yr. of Degree/
Attended Grad. Diploma
================================================================
High School
________________________________________________________________________
Undergrad.
________________________________________________________________________
Graduate
________________________________________________________________________
Graduate
________________________________________________________________________
Current Employment Status:

A. Are you currently employed? Yes______ No______
B. If yes, date of initial employment: _________________ Position: _______________
C. School/Company: _______________________ Address: ______________________
D. May we contact your present employer? Yes______ No______
E. Have you ever worked for SAU 68? Yes______ No______ If yes, when_________
List Membership in Education, Civic, Community Organizations & any position held:
List honors and accomplishments: (publication, awards, etc.)

References: List 3 references, including supervisors under whom you have worked, these people
should have first hand knowledge of your effectiveness in the work place. The applicant is
responsible to have reference letters as well as placement papers forwarded.
1. ____________________________________________________________________
Company Name Contact/Position Tel. No.
____________________________________________________________________
Street City/Town State Zip
2. ____________________________________________________________________
____________________________________________________________________
Street City/Town State Zip
3. ____________________________________________________________________
____________________________________________________________________
Street City/Town State Tel. No.
================================================================
COACHES ONLY:
Playing Experience in Sports:

Sport Level of Play Location(s)
_____________________ _____________________ ______________________
_____________________ _____________________ ______________________
_____________________ _____________________ ______________________
Previous Coaching Experience:

Sport Dates Level of Play Location(s)
_______________ ______________ ________________ __________________
_______________ ______________ ________________ __________________
_______________ ______________ ________________ __________________
================================================================
OFFICE PERSONNEL ONLY:
Office Machines/Equipment: ______________________________________________
Computer Hardware/Software Experience: ___________________________________
================================================================
CUSTODIAL/MAINTENANCE PERSONNEL ONLY:

Please list any areas of experience or skills:
______ carpentry ______ plumbing ______ other __________
______ boiler/burner exp. ______ painting ______ welding

______mixing/storage of cleaning chemicals ______ electrical
================================================================
SUBSTITUTES ONLY:
Please check appropriate schools, grade levels and/or subject areas, in which you are
interested.
_______________________________________________________________
School Grades Grades Lunch Nurse Custodian
________________________________________________________________________
Lin-Wood Elem. K-5
________________________________________________________________________
Lin-Wood Mid. 6-8
________________________________________________________________________
Lin-Wood HS. 9-12
________________________________________________________________________
================================================================
TEACHERS ONLY:
Full-Time Teaching Experience:
Dates
School Location # of months From /To and/or subject
TRANSCRIPTS: PLEASE ATTACH TRANSCRIPTS/PLACEMENT PAPERS. TEACHER

APPLICANTS MUST ALSO HAVE OFFICIAL TRANSCRIPTS SENT.
Certification: NH Certification ________________ _________________

Endorsement # Expiration Date
________________ _________________
Endorsement # Expiration Date
Certification in other states:

____________ ________________ ___________
State Type/Area (s) Exp. Date
(ATTACH COPY OF CERTIFICATION)
OTHER WORK EXPERIENCE:

________________________________________________________________________
Employer Location Dates Type of Work
I hereby certify that the facts set forth in the above employment application are true and complete to
the best of my knowledge. I understand that if employed, falsified statements on this application
shall be considered sufficient cause for dismissal.
Signed: ______________________________________ Date: ____________________
CONSENT:
In keeping with my candidacy for employment, I hereby consent that any bonafide law enforcement
agency be permitted to examine and obtain copies of all pertinent documents relating to my prior
positions of employment, education, and in addition, any and all other forms of documentation that
may address my background.
I understand information gathered by any law enforcement agency will become property of the
School Administrative Unit #68 and will not be disclosed to myself and may not be disclosed to any
other person or police department without my express consent.
I am willing that a photostat of this authorization be accepted with the same authority as the original.
Signed: _____________________________________ Date: _____________________
Applications remain on file until December 31 of each year.
================================================================
OFFICE USE ONLY
Date of Hire: _______________ Date Approved by Board: __________________
Date of Reference Check: _______________ Date of Police Check: ____________
Rate of Pay: _______________ First Day of Work: _______________
Number of Hours per day: _______________
Position (be specific):
Employer Signature: ______________________________________________________

================================================================

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LINCOLN-WOODSTOCK COOPERATIVE

Date: ____________ Telephone: ____________________ Cell: ___________________

Social Security Number: _________________________ Date of Birth: ______________

Home Address: ___________________________________________________________

Mailing Address: _________________________________________________________

Email Address: ___________________________________________________________

Position Applying For: (Please Check)

______ Teacher/Specialist ______ Administrator ______ Substitute

Current Employment Status:

List honors and accomplishments: (publication, awards, etc.)

Playing Experience in Sports:

Previous Coaching Experience:

OFFICE PERSONNEL ONLY:

Office Machines/Equipment: ______________________________________________

Computer Hardware/Software Experience: ___________________________________

CUSTODIAL/MAINTENANCE PERSONNEL ONLY:

______ boiler/burner exp. ______ painting ______ welding

TRANSCRIPTS: PLEASE ATTACH TRANSCRIPTS/PLACEMENT PAPERS. TEACHER

Certification: NH Certification ________________ _________________

Certification in other states:

OTHER WORK EXPERIENCE:

Signed: ______________________________________ Date: ____________________

Signed: _____________________________________ Date: _____________________

Applications remain on file until December 31 of each year.

Date of Hire: _______________ Date Approved by Board: __________________

Date of Reference Check: _______________ Date of Police Check: ____________

Rate of Pay: _______________ First Day of Work: _______________

Number of Hours per day: _______________

Position (be specific):

Employer Signature: ______________________________________________________

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Date: Telephone: Cell: _______

Social Security Number: ___________ Date of Birth:

Teacher/Specialist Administrator __ Substitute

boiler/burner exp. painting __ welding

Certification: NH Certification _

Signed: __________________ Date:

Signed: _________________ Date: _

Date of Hire: _ Date Approved by Board: ____

Date of Reference Check: ___ Date of Police Check:

Rate of Pay: _ First Day of Work: _