RE-1 Valley School District Application for Classified Employment

301 Hagen y Sterling, Colorado 80751-3915 (Please TYPE or PRINT in black ink)
Phone: (970) 522-0792 y FAX: (970) 522-0525 All areas of application must be completed, resumé
www.re1valleyschools.org may be attached - do NOT write "see resumé."
We are an Equal Opportunity Employer Incomplete applications will not be considered.

Area of Interest: Please number any position(s) you are interested in by order of interest (1=1st Choice, 2=2nd Choice, etc.)
*Paraeducator Childcare Assistant (After School Club/Kinder Club) Kitchen Manager
*Sub Paraeducator X Summer Club Sweeper
Early Educator (Preschool) Bus Driver Sub Sweeper
Accountant Sub Bus Driver Custodian
Secretary Food Service Summer Maintenance
Sub Secretary Sub Food Service Other (specify):
*MUST provide documentation of Associates degree, 48 hours college credit or Work Keys Proficiency Certificate for Para

School/Building Location Preference: 1st Choice: Hagen 2nd Choice:

Personal Information:
First Name: Middle Initial: Last Name: Social Security #:
Kendra A. Koehler 521-49-1179
Present Mailing/Street Address: City: State: Zip:
108 E. Arapahoe St. PO 'Box 293 Fleming Colorado 80728
How long at this address? _______Year(s)
3 Home Phone:(____)
970 Are you 18 years of age or over? Are you a U.S. Citizen?
Less than 2 years, list previous address w/city, state: ________________
265-2289
___________________________________ 970 X
_____Yes _____No
Work Phone:(_____) _____Yes
X _____No
________________
522-1409
May we contact you at work? E-Mail address:
X
______No _____Yes--Best time to call:_________
7-9 a.m. / p.m. kendranab@kci.net or dajakeko@gmail.com

Education: Beginning with high school, please list any formal education
Name of School: Location: Dates Attended: Degree Obtained or
# Credit Hours Earned:
High School:
X
_____ Diploma _____GED
Fleming High School Fleming, Colorado

CCC Online Sterling, Colorado Aug 2011 - present Projected Graduation May 2017

Personal References: (Non-relatives; do not include current or past employers listed in work experience on next page)
Name COMPLETE Mailing Address Phone (w/area code) Reference's Position/Title

Yvonne Lee 1812 Robin Road Sterling, Co. 80751 970-522-1409 Kitchen Manager

Carol Scheck 519 Pantall St. Sterling, Co. 80751 970-522-6967 Former co-worker

Jean Smets 1805 Pheasant Ridge Sterling, Co. 80751 970-522-1188 Former co-worker

Revised 01/2008 Page 1 of 2

 Experience: List all employment experience; arrange information in sequential order, beginning with current or most recent
X
employer. May we contact your current employer at this time? _____Yes _____No _____Not Employed
Dates Employed
Employer Complete Mailing Address Phone Supervisor (MM/DD/YYYY)
From: 04/28/2012
RE-1 Valley Schools 301 Hagen St. Sterling, Co. 970-522-0792 Kay Wernsman To: present
Position/Job Title: Cook Job Duties: Preparing and cooking/baking food; cleaning, dishes, serving
up to 400 children, staff, and parents a day
Reason for leaving:
Dates Employed
Employer Complete Mailing Address Phone Supervisor (MM/DD/YYYY)
From: 3/20/1999
Major Liquors 529 Iris Drive Sterling, Co. 970-522-2823 Craig Coberly To: 12/31/2006
Position/Job Title: Sales Clerk Job Duties: Tending cash drawer, light cleaning, ordering merchandise,
stocking, customer service.
Reason for leaving: To stay home with two small children
Dates Employed
Employer Complete Mailing Address Phone Supervisor (MM/DD/YYYY)
From: 3/22/1997
Sixth Street Foods 217 Hamilton St. Sterling, Co 970-522-2904 Carri Tanner To: 3/20/2000
Position/Job Title: Deli Clerk/Cook Job Duties: Preparing Cooking and baking foods, serving, stocking,
cleaning, customer service
Reason for leaving:
Dates Employed
Employer Complete Mailing Address Phone Supervisor (MM/DD/YYYY)
Sykes Enterprises 777 N. 4th St. Sterling, Co 970-6683 Terry Stewart From: 11/15/95
To: 1/26/97
Position/Job Title: Computer Technical Support Job Duties: Phone technical support for Apple computers, Help desk
support for fellow staff.
Reason for leaving: High stress; I'm not capable of working at a sedentary job, I have to be able to move around and do several projects.
Additional work history may be completed on a separate sheet and attached.
z Have you ever been terminated or resigned under threat of discharge from any job? __No X __Yes: If yes, provide details:

Comments, additional qualifications:

Have you ever been convicted of a felony or a misdemeanor (other than minor traffic offences)?
z ____No ____Yes
X
If yes, complete details are required on a separate sheet stating the date, the charge, the place and the action taken.
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of
all statements contained in this application for employment as may be necessary in arriving at an employment decision.
I understand that this is not and is not intended to be a contract of employment and that any offer of employment is
subject to the determination that I can perform the essential functions of the job, with or without reasonable
accommodation. In the event of employment, I understand that false or misleading information given in my application
or interview(s) may result in discharge.

z Signature of Applicant: Date:

Please return application to:
RE-1 Valley School District
301 Hagen Street Ø Sterling, Colorado 80751-3915
FAX: (970) 522-0525

Revised 01/2008 Page 2 of 2

 RE-1 Valley School District
Reference Request 301 Hagen Street
Sterling, Colorado 80751
(970) 522-0792 z (970) 522-0525 FAX

The person named below has applied for employment with our organization and has authorized
us to contact you as a reference. We would greatly appreciate it if you would furnish the
information requested for either a personal or employment reference as checked below.
Information obtained from you will be held strictly confidential. Please refold this form and tape
before mailing. Your earliest response will be most appreciated. Thank you for your
assistance.

X_____________________________________________
Authorization by applicant to release information
APPLICANT – DO NOT WRITE BELOW THIS LINE
Applicant's Name:
Position for which applicant is applying:

X PERSONAL REFERENCE EMPLOYMENT REFERENCE

TO:_____________________________
Yvonne Lee TO:_____________________________
Association:_______________________
Kitchen Manager Dates of employment:
(friend, business associate, etc.) From:____________ To:____________
Number of years known:____________
1 Last job title:______________________
Please complete upper portion of chart below Were services satisfactory? Yes No
Would you rehire? Yes No
Why did applicant leave employment?

Please complete chart below

My opinion of this applicant is as follows: Excellent Good Satisfactory Poor
Dependability
Honesty
Ability to establish and maintain effective
interpersonal relationships
Ability to work with others
Ability to follow instructions
Punctuality and attendance
Reaction to supervision
Professional knowledge

Additional Remarks:

Signature:__________________________________________ Date:____________________________

Title:_______________________________________________

January 2008
 RE-1 Valley School District
Reference Request 301 Hagen Street
Sterling, Colorado 80751
(970) 522-0792 z (970) 522-0525 FAX

The person named below has applied for employment with our organization and has authorized
us to contact you as a reference. We would greatly appreciate it if you would furnish the
information requested for either a personal or employment reference as checked below.
Information obtained from you will be held strictly confidential. Please refold this form and tape
before mailing. Your earliest response will be most appreciated. Thank you for your
assistance.

X_____________________________________________
Authorization by applicant to release information
APPLICANT – DO NOT WRITE BELOW THIS LINE
Applicant's Name:
Position for which applicant is applying:

PERSONAL REFERENCE X EMPLOYMENT REFERENCE

TO:_____________________________ TO:_____________________________
Craig Coberly
Association:_______________________ Dates of employment:
(friend, business associate, etc.) From:____________
3/20/99 To:____________
12-31-06
Number of years known:____________ Last job title:______________________
Sales Clerk
Please complete upper portion of chart below Were services satisfactory? Yes No
Would you rehire? Yes No
Why did applicant leave employment?

Please complete chart below

My opinion of this applicant is as follows: Excellent Good Satisfactory Poor
Dependability
Honesty
Ability to establish and maintain effective
interpersonal relationships
Ability to work with others
Ability to follow instructions
Punctuality and attendance
Reaction to supervision
Professional knowledge

Additional Remarks:

Signature:__________________________________________ Date:____________________________

Title:_______________________________________________

January 2008