Nell Holcomb - Non-Certified Job Application

The Nell Holcomb R-IV School District considers applicants for all positions without regard to race, color, religion, sex, national origin or disability. 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 Superintendent's office at 573.334.3644.

All applicants are expected to answer all questions on this application. Answer "none" or "not applicable" where necessary.

Name

Social Security Number

Date of Application

Date

Address

Street Address Line 2

CityState

Phone Number

Position for which you are applying

Pertinent Certifications/ Qualifications

Total years of pertinent experience

When could you begin work?

Additional information you wish to express concerning this application

Education

	Name and Address Of schools attended	Attendance Dates	Degree/Degrees	Major or Course of Study
High School
College/University
Graduate School
Other

Number of Undergraduate Hours

Number of Graduate Hours

Employment Experience (Most recent position first)

	Date Month/Year	Name and Address of Employer	Position	Monthly Salar	Reason for Leaving
Position 1
Position 2
Position 3
Position 4
Position 5

List any other special skills, training, or courses you have had which would enhance your abilities in the position of which you applying

Have you ever been arrested for, or charged with or convicted of a felony or misdemeanour? (Exclude traffic offenses for which you were not sentenced to jail or for which the fine was less than $100.)

Have you ever pleaded guilty or no contest to a felony or misdemeanour? (Exclude traffic offenses for which you were not sentenced to jail or for which the fine was less than $100.)

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, emotion, psychological or sexual abuse or neglect of a child?

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.

Personal References

	Name	Address	Phone Number	Position
Reference 1
Reference 2
Reference 3

READ CAREFULLY BEFORE SIGNING.

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

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.

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 consideration of my employment.

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 even 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.

Iunderstand that this application will be considered active through June 30th. I understand that if I wish my candidacy to remain open after that date I must submit another application.

Signature

Date

Employment Questions