Strafford R-VI School District

APPLICATION FOR A CERTIFICATED POSTION

The Strafford School District considers applicants for all positions without regard to race, color, religion, sex, national origin or disability. 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: ____________________________________________________

Subject(s) _____________________________________ Grade Level(s) ________________________

Are you available for substitute teaching? ______ Paraprofessional? ___________________________

Extra duty positions you may be interested in sponsoring or coaching: ___________________________

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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 & Location	Position	Dates of Employment	Number of Years	Supervisor	Phone

Other Work Experience:

Employer Name & Location	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) ______________________________________________________________________________

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: ___________________________________________

Salary step and level: _______________________________________

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Name: _____________________________________ Social Security # _____________________

Please respond to the following questions in your own handwriting.

1. Why have you chosen education as your profession?

2. What student outcomes would you strive for as a teacher?

3. Write a brief autobiography focusing on the important people and events in your life.