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 Summer Club Sweeper
Early Educator (Preschool) Bus Driver Sub Sweeper
Accountant Sub Bus Driver Custodian
Secretary X Food Service Baker at Ayres Elementary 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: Ayres Elementary 2nd Choice: Sterling High School

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

3
How long at this address? _______Year(s) 970
Home Phone:(____) 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
Work Phone:(_____) X
_____Yes _____No X
_____Yes _____No
571-2626
________________
May we contact you at work? E-Mail address:
X
______No _____Yes--Best any
time to call:_________ a.m. / p.m. kendranab@kci.net

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
Colorado Community College
Online Sterling, Colorado Fall 2011-Present 28 Credit Hours

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

Connie Ernst 1161 Sidney Ave. Sterling, Co. 970-466-2823 Manager @ Baja Tacos

Kathy Peterson 518 California St. Sterling, Co. 970-522-9298 Manager @ Sterling High
Lola Jordan 148 Acoma St. Sterling, Co. 970-522-0695 Manager @ Campbell

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: Apr 2012
RE-1 Valley School 301 Hagen St. Sterling, Co. 970-522-0792 Kay Wernsman To: present
Position/Job Title: Substitute Cool Job Duties: Dishes, Serving, Cleaning, assisting head
and assistant cooks
Reason for leaving: N/A
Dates Employed
Employer Complete Mailing Address Phone Supervisor (MM/DD/YYYY)
From: Apr 2009
Baja Tacos 233 Broadway Sterling, Co. 970-522-5563 Jack Schneider To: Mar 2012
Position/Job Title: Cook/Cashier Job Duties: Preparing, cooking, and serving foods,
tending cash register, cleaning, dishes, and customer service.
Reason for leaving:
Dates Employed
Employer Complete Mailing Address Phone Supervisor (MM/DD/YYYY)
From: Mar 1999
Major Liquors 529 Iris Dr. Sterling, Co. 970-522-2383 Craig Coberly To: Dec 2006
Position/Job Title: Sales Clerk Job Duties: Tending cash register, stocking, ordering,
light cleaning, and customer service.
Reason for leaving: To stay home with small children.
Dates Employed
Employer Complete Mailing Address Phone Supervisor (MM/DD/YYYY)
From: Mar 1997
Sixth St. Foods 217 Hamilton St. Sterling, Co. 970-522-2904 Carri Tanner To: Mar 2000
Position/Job Title: Deli Clerk/Cook Job Duties: Preparing, cooking, baking, serving foods,
catering, cake decorating, customer service.
Reason for leaving: To work full time at the liquor store.
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? X
__No __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 X
____Yes
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: Kendra Koehler
Position for which applicant is applying: Baker at Ayres Elementary

XPERSONAL REFERENCE EMPLOYMENT REFERENCE

Connie Ernst
TO:_____________________________ TO:_____________________________
Association:_______________________
Friend for three yrs and co-worker Dates of employment:
(friend, business associate, etc.) From:____________ To:____________
4
Number of years known:____________ 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: Kendra Koehler
Position for which applicant is applying: Baker at Ayres Elementary

PERSONAL REFERENCE
X EMPLOYMENT REFERENCE
TO:_____________________________ Kathy Peterson
TO:_____________________________
Association:_______________________ Dates of employment:
(friend, business associate, etc.) Apr 2012
From:____________ Present
To:____________
Number of years known:____________ Substitute Cook
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