Clarksburg C

Clarksburg C-II School District

Application for Non-Certified Positions

401 South Highway H

Clarksburg, MO 65025

Phone (573)787-3511 Fax (573)787-3667

The 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 the 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 Administration at the above address.

Please provide the following contact information:

First Name

Last Name

Middle Initial

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

E-mail

What type of employment do you wish to be considered for?

Full-time
Part-time

When would you be available for employment?

-- mm/dd/yy

Work Experience

List the most recent first

Name of Company and Location                       Type of Work                                   Dates Employed









Have you ever been convicted of a felony or crime?

If yes, please explain:

References

                   Name                                           Official Position                                     Complete Address







I certify that the facts set forth in this application are true and complete, and I hereby authorize Clarksburg C-II School District to collect information concerning my character, personality and work ability.

Clarksburg C-II School District is an Equal Opportunity and Affirmative Action employer.