Certified Teaching Application

Certified Teaching Position Application

21051 Highway D Marshall, MO 65340

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.
Full Name
Social Security Number
Names that may appear on your transcripts or records
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Permanent Address (if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E mail address (optional)
example@example.com
Date Available for position

MonthDayYear
Date
Position Applying For
Certification Type (Lifetime, PC1, etc.) or Other
State(s)
Subject Area(s)
Grade Level(s)
Expiration Date
Other information regarding your certification and/or certification status:
Education 1
School Name
Location
Dates of Attendance
Graduation Date
Major and Degree
Overall GPA
Credit Hours Earned
Education 2
School Name
Location
Dates of Attendance
Graduation Date
Major and Degree
Overall GPA
Credit Hours Earned
Education 3
School Name
Location
Dates of Attendance
Graduation Date
Major and Degree
Overall GPA
Credit Hours Earned
Teaching Experience 1
District Name & Address
Position
Dates Employed
Number of Years Employed
Name of Supervisor
Phone Number
Please enter a valid phone number.
Teaching Experience 2
District Name & Address
Position
Dates Employed
Number of Years Employed
Name of Supervisor
Phone Number
Please enter a valid phone number.
Teaching Experience 3
District Name & Address
Position
Dates Employed
Number of Years Employed
Name of Supervisor
Phone Number
Please enter a valid phone number.
Reference 1
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position
Reference 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position
Reference 3
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position
Employment Questions: (Please select the correct answer in the drop down below)
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 time or for which the fine was less than $100.00)
2. Have you ever pled guilty or no contest to a felony or misdemeanor? (Exclude traffic offenses for which you were not sentenced to jail time 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 you answer yes to any question, please explain:
I 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 registering and completing a fingerprint background check utilizing the Missouri Automated Criminal History Site (MACHS), following the procedures given to me, upon my employment by the District.

I certify that the information given in this application is true, accurate 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.

I understand that this application is the property of the Hardeman R-10 School District, which reserves the right to accept or reject it. I understand that this application is active for 120 days from the date signed and if wish it to remain open active after this date, I must submit another application.
Signature and Date Signed

Clear
Should be Empty:

Education 1

Education 2

Education 3

Teaching Experience 1

Teaching Experience 2

Teaching Experience 3

Reference 1

Reference 2

Reference 3

Employment Questions: (Please select the correct answer in the drop down below)