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:

__________________________________    ________________________________    _____________

__________________________________    ________________________________    _____________

__________________________________    ________________________________    _____________
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