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

NON DISCRIMINATION NOTICE
 
 

Leopold R-III School District does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. The following person has been designated to handle inquiries regarding the non-discrimination policies:

Keenan Kinder
Superintendent
100 Main Street
Leopold MO 63760
573-238-2211

For further information on notice of non-discrimination, visit http://wdcrobcolp01.ed.gov/CFAPPS/OCR/contactus.cfm for the address and phone number of the office that serves your area, or call 1-800-421-3481.