Fillable SCOTT CITY R-I SCHOOL DISTRICT (City of Oakland)

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SCOTT CITY R-I SCHOOL DISTRICT (City of Oakland)

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APPLICATION FOR EMPLOYMENT - CERTIFICATED POSITION
SCOTT CITY R-I SCHOOL DISTRICT
3000 Main Street Phone: 573.264.2381
Scott City, MO 63780 Fax: 573.264.2206
The Scott City R-I 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 the
Superintendent in central office.
All applicants are expected to answer all questions on this application. Answer "none" or
"not applicable" where necessary.
Name:
Date:
Other names that may appear on your transcripts or records:
Social Security Number:
Current Address (Street, City, State, Zip):
Current Phone: Permanent Phone:
Permanent Address (Street, City, State, Zip):
Position(s) for which you are applying:
Date Available to Begin Work:
Certification Status:
Type (Life, PC1, Career, Etc.):
State(s): Subject(s):
Grade Level(s): Expiration date(s):
Other information regarding your Certification and/or certification status:
Subject(s): Grade Level(s):
MO
Are you available for substitute teaching?
Paraprofessional?
Extra duty positions you may be interested in coaching & indicate any experience:
Extra duty positions you may be interested in sponsoring & indicate any experience:
NOTE: Please attach Resume to this application if available.
Educational Preparation, Teaching Experience, and Work Experience need not be listed if
included on attached Resume.
Educational Preparation:
NAME &
LOCATION
NAME OF DEGREE MAJOR
OVERALL
GPA
HIGH SCHOOL
N/A N/A N/A
COLLEGES/
UNIVERSITIES
Yes
No
Yes
No
Teaching Experience (If none, list student teaching experience):
DISTRICT NAME
& LOCATION
POSITION
DATES OF
EMPLOYMENT
SUPERVISOR PHONE
Other Work Experience:
EMPLOYER NAME &
LOCATION
POSITION
DATES OF
EMPLOYMENT
SUPERVISOR PHONE
References:
NAME
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 jurisdiction, 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:
No
Yes
Yes
No
Yes
No
Yes
No
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 six months from date of application. I
understand that if I wish my candidacy to remain open after that date I must submit another application.
_________________________________________________________ _______________________
Signature Date
****************************************************************************
Do Not Write Below This Line - For Administrative Use Only
Date received: Application___________ Credentials____________ Transcripts_________
Date interviewed:___________________ Interviewed by:_____________________________
Reference contacted: Name, date ___________________________________________________
Date: Applicant notified__________________Date: Applicant accepted______________________
Position offered: _______________________________Salary step and level: ________________
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APPLICANT QUESTIONS
Name: Social Security #:
Please respond to the following questions.
1. Why have you chosen teaching as your profession?
2. What student outcomes would you strive for as a teacher?
(continued on next page)
3. Write a brief autobiography focusing on the important people and events in your life.
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SCOTT CITY R-I SCHOOL DISTRICT (City of Oakland)

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Completed 6 April 2022

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