Non-Certified Application

Non-Certified Application
NEW MADRID COUNTY REORGANIZED SCHOOL DISTRICT NO. 1, ENLARGED

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

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

Bridgett Masterson, Superintendent
EMPLOYMENT APPLICATION
Application Date

MonthDayYear
Date
Name
Social Security #
Street Address
City
State
Zip Code
Telephone
Email
example@example.com
School Attended
Highest grade completed
College Hours
If not a graduate. why did you quit?
Names of any relatives or close friends employed by this school district
Position applying for
Salary desired
Bus Driver Applicants only: Current CDL?

YesNo
Missouri School Bus Permit?

YesNo
List skills you have which qualify you for a job,
Are you presently employed?
Employer
Have you ever been convicted of a felony?

YesNo
Please give information requested concerning the last three jobs you have held:
Employer
Salary
Job Duties
Dates
Reason for Leaving
Employer
Salary
Job Duties
Dates
Reason for Leaving
Employer
Salary
Job Duties
Dates
Reason for Leaving
REFERENCES

Please provide 3 references
1. Name
1. Position or Title
1. Phone Number
Please enter a valid phone number.
2. Name
2. Position or Title
2. Phone Number
Please enter a valid phone number.
3. Name
3. Position or Title
3. Phone Number
Please enter a valid phone number.
Signature

Clear
Incompliance with federal law including provision of Title Vfof the Civil Rights Act of 1964, Title IXof the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973. and Title II of the American with Disabilities Act of 1992. The New Madrid County basis of roce. color. national origin, sex, age. or handicap in its education programs, activities or employment policies.
Should be Empty:

Non-Certified Application

EMPLOYMENT APPLICATION

REFERENCES