Certified Teacher Application

Certified Teacher Application
REORGANIZED SCHOOL DISTRICT NO. 1, ENLARGED

310 U.S. Highway 61 New Madrid, MO 63869

Phone: (573)688-2161 Fax: (573)688-2169

Bridgett Masterson, Superintendent
Application Date

MonthDayYear
Date
Name
Social Security #
Address/City/State/Zip)
Phone
Email
example@example.com
College Degrees
Date earned

MonthDayYear
Date
Type of certificates
Subject or areas qualified for
Position applied for: (grade or subject in preference order)
SCHOOLS ATTENDED
High School Name
City
State
Years Attended
Degree
College or University
City
State
Years Attended
Degree
College or University
City
State
Years Attended
Degree
College or University
City
State
Years Attended
Degree
Semester Undergraduate Hours
Semester Graduate Hours
Have you ever been convicted of a felony?

YesNo
In compliance with federal law including provision of Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilita- tion Act of 1973. and Title II of the American with Disabilities Act of 1992. The New Madrid County R-1 School District does not discriminate on the basis of race. color. national origin, sex, age. or handicap in its education programs, activities or employment policies.
TEACHING EXPERIENCE
Employed By
City
State
Dates
Position/Subject Taught
Employed By
City
State
Dates
Position/Subject Taught
Employed By
City
State
Dates
Position/Subject Taught
Employed By
City
State
Dates
Position/Subject Taught
Present Salary
Earliest convenient interview date

MonthDayYear
Date
Check activities which you can direct successfully:

PlaysDebateSchool PupblicationsOrchestraBandAthleticsSinging GroupsSchool Yearbook
Other Activities
Clubs
Major Subject
Semester Hours
Minor Subject
Semester Hours
Practice Teaching Completed?

YesNo
Date of completion

MonthDayYear
Date
Practice Teaching School
Grade or Subject
Other pertinent information:
REFERENCES
1. Name
1. Address
1. Phone Number
Please enter a valid phone number.
2. Name
2. Address
2. Phone
Please enter a valid phone number.
3. Name
3. Address
3. Phone
Please enter a valid phone number.
Signature of Applicant

Clear
Signature of Applicant By Typing your name above you are acknowledging that the information enteredon this applications tue and accurate to the best of your knowledge
Should be Empty:

Certified Teacher Application

SCHOOLS ATTENDED

TEACHING EXPERIENCE

REFERENCES