APPLICATION - CERTIFIED

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 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 Adam Cook at 417-741-7676. All applicants are expected to answer all questions on this application. Answer “none” or “not applicable” where necessary.

Date*

Date

Name*

First NameMiddle NameLast Name

Other names that may appear on your transcripts or records*

Social Security Number*

Current Address*

Current Address

Street Address Line 2

CityState

Zip

Current Phone*

Permanent Address*

Permanent Address

Street Address Line 2

CityState

Zip

Permanent Phone*

Preferred Email Address*

Date Available*

Date

Position(s) for which you are applying*

Skills you possess pertaining to the position(s) for which you are applying*

Certifications You Hold*

High School: Name and Location*

Educational Preparation*

	Name & Location	Dates Of Attendance	Name Of Degree	Major	Overall GPA
Colleges/ Universities
-
-
BUSINESS/ TRADE SCHOOLS
-

Total number of college hours*

Work Experience:*

	Employer Name & Location	Position	Dates Of Employment	Number Of Years	Supervisor	Phone
-
-
-
-
-

References:*

	Name	Address	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)*

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;*

READ CAREFULLY BEFORE SIGNING

I acknowledge and agree to the following provisions as conditions for consideration of my application for employment:

1. I hereby authorize my current and former employers and references to furnish any information about me and 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 one year. I understand that if I wish my candidacy to remain open after that date, I must submit another application.

Signature*

Clear

Date*

Date

APPLICANT QUESTIONS

1. Why have you chosen the position, for which you are applying as your profession?*

2. Describe how you would be able to help the students in our School District.*

3. Write a brief autobiography focusing on the important people and events in your life.*

FBI/Highway Patrol Background Check Procedures

Scheduling an Appointment (Missouri residents)

To be fingerprinted for the Department of Elementary and Secondary Education through 3M/Cogent, you must register with MACHS, which is located at www.machs.mo.gov.

Individuals without access to the Internet may contact the fingerprint processing company, 3M/Cogent, directly at 1-877-862-2425 to have a Fingerprint Services Representative conduct this registration on their behalf. To register with the Missouri Automated Criminal History Site (MACHS) for a fingerprint, you must have a 4-digit registration code. This code ties all agency-identifying information together to ensure that your background check response is returned to the correct agency. Below are the codes to use for Hartville R-II Schools.
2196 Certified Teachers
2197 Substitutes
2198 Uncertified
2199 Bus Drivers

Fingerprinting Fee

The fee for the fingerprinting process is $44.80. You will have the option to make this payment online at the time of registration or at your appointment.

Scheduling an Appointment (Non-Missouri residents)

If you live outside the state of Missouri and cannot make an appointment for fingerprinting in Missouri, you may mail fingerprint cards directly to 3M/Cogent. You will need to contact the fingerprint processing company, 3M Cogent, at 1-877-862-2425 to make sure all information is recorded on the FBI fingerprint cards correctly before mailing them. The fee for this process is $44.80. A check or money order must be made payable to 3M/Cogent.

Fingerprint Results

If you are an educator, substitute teacher, or student teacher, your fingerprint information will be recorded automatically on your profile page in the online Educator Certification System. If you are an uncertified staff member or a bus driver, your results will be forwarded to the school district based upon the registration code you provided. Results of fingerprints are generally reported to the Educator Certification within 2-3 weeks from the date of appointment.

Additional information about the fingerprinting process may be viewed at the following websites:
http://dese.mo.gov.eq/cert/eq-cert-fingerprint-background.htm
http://dese.mo.gov/forms/documents/ApplicantsPrivacyRights.pdf

APPLICATION FOR A CERTIFICATED POSITION