Strafford R-VI School District Applications

Strafford R-VI School District

APPLICATION FOR AN ADMINISTRATIVE POSITION

The Strafford School District considers applicants for all positions without regard to race, color, religion, sex, national origin or disability. If you have a disability or handicap which may require accommodation for you to participate in our application process (including filling out this form, interviewing or any other pre-employment procedure or requirement), please make us aware of any accommodation you feel is necessary. If you have any inquiries, complaints or concerns about any pre-employment procedure or requirement, including completing this application, or about the district policy of non-discrimination, you may contact John Collins at (417)736-7000.

All applicants are expected to answer all questions on this application. Answer “none” or “not applicable” where necessary.

Date ____________________________________ Date Available ____________________________

___________________________________________________________________________________

Last Name First Name Middle Name

Other names that may appear on your transcripts or records: __________________________________

Social Security Number _____________________

Current Address _____________________________________________________________________

Street City State Zip

Current Phone ( )________________________

Permanent Address ___________________________________________________________________

Street City State Zip

Permanent Phone ( )______________________

Certification: Type ___________________________ (Life, PC1, Etc.) Other __________________

State(s) _____________________________________ Subject(s) ____________________________

Grade Level(s) _______________________________ Expiration Date(s) ______________________

Other information regarding your Certification and/or certification status: ________________________

____________________________________________________________________________________

Position(s) for which you are applying: ____________________________________________________

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Educational Preparation:

High School Colleges/ Universities	Name & Location	Dates of Attendance	Name of Degree	Major	Overall GPA

Teaching Experience (If none, list student teaching experience):

District Name & Address	Position	Dates of Employment	Number of Years	Supervisor	Phone

Administrative Experience:

District Name & Address	Position	Dates of Employment	Number of Years	Supervisor	Phone

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References:

Name	Address	Phone	Position

Employment Questions:

1. Have you ever been arrested for, or charged with or convicted of a felony or misdemeanor? (Exclude traffic offenses for which you were not sentenced to jail or for which the fine was less than $100.00)

___________________________________________________________________________________

2. Have you ever pleaded guilty or no contest to a felony or misdemeanor? (Exclude traffic offenses for which you were not sentenced to jail or for which the fine was less than $100.00)

____________________________________________________________________________________

3. Has the Missouri Division of Family Services or a similar agency in any other state or juris-diction, ever issued a determination or finding of cause or reason to believe or suspect that you have engaged in physical, emotional, psychological or sexual abuse or neglect of a child?

____________________________________________________________________________________

4. Have you ever failed to be re-employed by an educational institution? _____________________

If the answer to any of the foregoing questions is “yes” please explain; use a separate sheet if necessary:

____________________________________________________________________________________

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READ CAREFULLY BEFORE SIGNING

I acknowledge and agree to the following provisions as conditions to consideration of my application for employment:

1. I hereby authorize my current and former employers and references to furnish any information about me and about my work experience. I release my current and former employers and references from any and all liabilities or damages of any nature as a result of providing such information. My current and former employers and references may rely on a signed copy of this release.

2. I understand and consent to having criminal and arrest records checks as well as background checks by the Missouri Division of Family Services as a condition for consideration of my application for employment.

3. I certify that the answers given in this application are true and complete to the very best of my knowledge. In the event I am employed by the District and in the further event that I have provided false or misleading information in this application or in subsequent employment interviews, I understand that my employment may be terminated at any time after discovery of the false or misleading information.

4. I understand that this application will be considered active for one year. I understand that if I wish my candidacy to remain open after that date I must submit another application.

_________________________________________ ___________________________________

Signature Date

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Do Not Write Below This Line – For Administrative Use Only

Date received: Application _____________ Credentials _____________ Transcripts _____________

Date interviewed: ____________________ Interviewed by: _________________________________

Date and time: Applicant notified _____________________________

Date and time: Applicant accepted ____________________________

Position offered: ___________________________________________