Application for Certified Teaching Position

Marshall Public School District

860 W. Vest

Marshall, MO   65340

(660)886-7414

 

We afford equal opportunity to qualified individuals regardless of their age, race, color, national origin, ancestry, religion, socio-economic status, marital status, sex, handicaps or memberships in legally constituted organizations to the extent required by all applicable laws.

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POSITION DESIRED

 

 Early Childhood                                      Grade:      

 Elementary School (K-4)                                           

 Middle School (5-8)                     Subject Area:      

 High School (9-12)

 Vocational/Career Center (9-12)

 Special Education

 Other Teaching Position

PERSONAL INFORMATION

Name:      

Date of Application:

     

Present Address:     

 

Telephone Number(s)     

Social Security Number (Optional)

     

Permanent Address (if not same as above)     

 

Permanent Telephone Numbers (if not same as above)     

 

E-mail Address (Optional):     

 

 

Are you a United States citizen or able to work legally in this country?       Yes  No

Have you ever been convicted of a crime?                                               Yes  No

Are you presently under contract with any school district for next year?    Yes  No

 

Present Position      

 

Are you willing to accept after-school responsibilities?      Yes  No

 

What activities do you feel qualified to sponsor/coach?         

 

Date available for employment      

 

Missouri Retirement System Number: ______________________________________________________

NOTE:  Mark X in the blank if you have never belonged to the System or if your contribution has been withdrawn.

 

Certification Area

Grade Levels

Life or Date Certification Expires

     

 

     

     

     

 

     

     

     

 

     

     

     

 

     

     

     

 

     

     

 

EDUCATIONAL BACKGROUND

Name/Location

Dates Attended

Graduation Date

Degree

Credit Hours Earned

     

 

     

     

     

     

     

 

     

     

     

     

     

 

     

     

     

     

     

 

     

     

     

     

     

 

     

     

     

     

PROFESSIONAL BACKGROUND (Teaching/Administrative Experience)

NOTE:  Begin with most recent

Name/Location

Assignment

Years Completed

Supervisor/Phone No.

Reason for Leaving

     

 

     

     

     

     

     

 

     

     

     

     

     

 

     

     

     

     

     

 

     

     

     

     

     

 

     

     

     

     

WORK EXPERIENCE (Other than Teaching)

NOTE:  Begin with most recent

Name/Location

Period of Service

Type of Work

Reason for Leaving

     

 

     

     

     

     

 

     

     

     

     

 

     

     

     

     

 

     

     

     

     

 

     

     

     

PROFESSIONAL MEMBERSHIPS

 

     

 

     

 

     

REFERENCES

List at least three references, especially supervisors, principals or superintendents under whom you have taught, who are qualified to answer questions concerning your fitness for the position you seek.

Name

Present Address

Phone Number

Official Position and Dates Acquainted With Your Work

     

 

 

     

     

     

     

 

 

     

     

     

     

 

 

     

     

     

 

ADDITIONAL INFORMATION

Briefly state what you feel you can contribute as an employee for the Marshall Public School District in the position for which you are applying.

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGREEMENT

I hereby certify that the above information to the best of my knowledge is true, accurate and complete.  Any misrepresentation or willful omissions of facts shall be sufficient cause for disqualification of this application or termination of employment.  Furthermore, it is understood that this application and records become the property of the Marshall Public School District which reserves the right to accept or reject it.  I further agree to observe all rules, regulations and policies of the Marshall Public School District now in force and effect or as they may change during my employment, if I am employed by the District.  I also hereby authorize the District to conduct a background investigation and authorize release of information in connection with my application for employment.  This investigation may include such information as criminal convictions, driving records, previous employers and educational institutions, personal references, professional references and other appropriate sources.  I waive my right of access to any such information, and without limitation hereby release the school district and the reference source from any liabilities in connection with its release or use.

 

 

                                                                                                  

 Signature of Applicant                                                                Date