PERSONAL                                                                                        Date________________________

Name_______________________________________________

Address_____________________________________________     Phone No.____________________

EMPLOYMENT DESIRED

Position______________________________________________    Date you can start_____________

EDUCATION            Name of School:                           Years Attended:                   Date Graduated:

High School     _______________________________    ___________________        ______________

College            _______________________________    ___________________        _______________

University        _______________________________    ___________________        _______________

TEACHING EXPERIENCE
Name & Address of School:                                        Grade or Subject Taught:             Dates:

_________________________________________    __________________________    ____________

_________________________________________    __________________________    ____________

_________________________________________    __________________________    ____________

REFERENCES
List three references who have first-hand knowledge of your character, personality, scholarship,
and teaching ability.

Name:                                                            Address:                                                    Position:

__________________________________    ________________________________    _____________

__________________________________    ________________________________    _____________

__________________________________    ________________________________    _____________
 
 

PAGE 2

Equal Opportunity Employer
 

APPLICATION FOR TEACHING POSITION
 

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
 further event that I have provided false or misleading information in this
 application or in subsequent employment interviews, I understand that my
 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 through April 30th.  I
 understand that if I wish my candidacy to remain open after that date I must
 submit another application.
 
 

______________________________________ __________________________
                          Signature                                                         Date

Print this application, complete it, and return it with any additional information you desire to:
Superintendent's Office, Leopold R-III School, P.O.Box 39, Leopold, MO  63760-0039