Support Staff

HARDEMAN R-10 SCHOOL DISTRICT 21051 HIGHWAY D

MARSHALL, MO 65340
Application for a Support Staff Position

The Hardeman School District considers applicants for all positions without regard to race. color. creed. 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 pre-employment procedure or requirement, including completing this application. or about the District policy of non-discrimination, you may contact Kristy Forrester at 660-837-3400.

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

MonthDayYear
Date
Name

First NameMiddle NameLast Name
Other names that may appear on your transcripts or records
Social Security Number
Address

Current Address

Street Address Line 2

City. State & ZipState / Province

Postal / Zip Code
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date Available

MonthDayYear
Date
Position(s) for which you are applying
Educational Preparation
College Degree/Vocational Degree
School Name
Dates of attendance
Name of Degree
Major
Overall GPA
Secondary School
Name of school
Dates of attendance
Reference 1
Name
Address
Phone
Position
Reference 2
Name
Address
Phone
Position
Reference 3
Name
Address
Phone
Position
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
2) Have you ever pleaded guilty or no contest to a felony or misdemeanor? (Exclude traffic offences 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 reemployed by an educational institution?
If the answer to any of the foregoing questions is "yes" please explain and use a separate sheet if necessary:
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. Missouri Automated Criminal History Site (MACHS following the procedures given to me, upon my employment by the District. 3.Icertify that the answers given inthis application are true and complete to the very best of my knowledge. In the event that I am employed by the District and in the further event that I have provided false ormisleading information inthis application or in subsequent employment interviews. lunderstand that my employment may be terminated at any time after discovery of the false ormisleading information. 4.I understand that this application will be considered active through April 30th. Tunderstand that if I wish my candidacy to remain open after that date, I must submit another application.

I understand and consent to registering and completing a fingerprint background check utilizing the
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Educational Preparation

College Degree/Vocational Degree

Secondary School

Reference 1

Reference 2

Reference 3