MORGAN COUNTY R-II SCHOOL DISTRICT 913 West Newton Versailles, MO Phone Fax

Transcription

1 MORGAN COUNTY R-II SCHOOL DISTRICT 913 West Newton Versailles, MO Phone Fax Office Use Only Assignment Building Hire Date Rate of Pay Classified Employee Application Please print or type Please check positions for which you are applying: ( ) Secretary ( ) Custodian ( ) Bus Mechanic ( ) Nurse ( ) Maintenance ( ) Bus Driver ( ) Paraprofessional ( ) Buildings/Grounds ( ) Other (Please Specify) (Requires 60 college hours) Would you work: Full Time Part-time Substitute Application Date: Date Available: Name: : First Middle (Maiden Name) PO Box/Street City State Zip : Social Security No. List someone who will always know your address. Do not list husband or wife. Name Have you ever been charged with, convicted or entered a plea, including a plea of nolo contendere, to any felony or misdemeanor whether or not sentence was imposed or suspended, except minor traffic violations? Yes No (If yes, explain fully.) Have you ever been denied a professional license, certificate, permit, credential, endorsement, or registration? Yes No (If yes, explain fully.) Has your professional license (except for driver s license), certificate, permit, credential, endorsement, or registration ever been disciplined, suspended, revoked, reprimanded, restricted, curtailed or voluntarily surrendered or do you have any pending complaints before any regulatory board or agency or is there any investigation or adverse action now pending against you? Yes No (If yes, explain fully.) Have you ever resigned, been restricted, disciplined, or discharged from any position, included the armed forces, while under suspicion of having engaged in criminal, immoral, unethical behavior or unprofessional conduct, or are you under investigation for any such charge? Yes No (If yes, explain fully.) SECRETARIAL APPLICANTS please complete: Check the skills in which you have had training or experience. Typing Data Entry Word Processing Computer Software (Describe) Other

2 NURSE APPLICANTS please complete: Are you registered in the state of Missouri? Yes No Lic. No. Exp. Date CPR Certified Yes No Exp. Date List experience in community health work and Health Education Programs. CUSTODIAL/MAINTENANCE/BUS MECHANIC/BUILDINGS/GROUNDS APPLICANTS please complete: Check the areas in which you have had training or experience: Electricity Furniture Building Welding Heavy Equip Mech. Plumbing Computer Operation Sheet Metal Stripped Floors Masonry Design Drafting Brakes Cleaned Carpets Roofing HVAC Trans/Drive line Lights/Electrical Painting Electronic/Electrical Licensed MVI Cleaned Restrooms Carpentry List experience in community health work and Health Education Programs. BUS DRIVER APPLICANTS please complete: CDL No. Issuing State Have you had ANY moving traffic violations within the last 5 years: Yes No (If yes, explain fully.) PARAPROFESSIONAL/P.A.T. APPLICANTS please complete: Have you attended college: Yes, tal Semester Hours (attach copy of Transcripts) No Do you have a Missouri Teaching Certificate No Yes, in the following areas Attach copy of certificate Do you have a CDA Certification? No Yes Have you worked in a licensed accredited child care center? No Yes Where and how long? Classified positions within the school district may require lifting, carrying 50 lbs., bending, reaching, pushing, walking, twisting, crouching, standing. Is there any reason why you can not perform these physical requirements?

3 EDUCATION School Name of School Institution Location Diploma or Degree Dates Attended Elementary High School College/University College/University List activities outside the classroom in which you participated actively while attending high school or college: College Major College Minor Enclose copy of transcript # of hours in Major # of hours in Ed. # of hours in Minor tal College Hours CERTIFICATION OR LICENSE (Enclose copy of certificate or license) EMPLOYMENT HISTORY Please give complete full-time and part-time employment record. with present or most recent employer.

4 We may contact the employers listed unless you indicate those you do not want contacted. Please explain why you do not want an employer contacted. Do Not contact for the following reason Have you ever been discharged or asked to resign from a position? Yes If yes, give reason. No REFERENCES Do not list relatives. List former employers, teachers, or others who can describe your qualifications. Name Mailing Relationship Is there any additional information relative to change of name or use of nickname necessary to enable a check on your work or school records? If yes, explain

5 I hereby certify that the information provided, to the best of my knowledge, is true, accurate and complete. Any misrepresentation or willful omission of facts shall be sufficient cause for disqualification of this application or termination of employment. I also hereby authorize the district to conduct a background investigation and authorize release of information in connection with my application for employment. This investigation may include such information as criminal convictions, child abuse, child neglect, previous employers and educational institutions, personal references, professional references and other appropriate sources. Request for Child Abuse or Neglect/Criminal Records Form will be submitted to the Division of Social Services and the Missouri State Highway Patrol as part of the employment process. Employment is considered temporary until satisfactory results are received from the appropriate agencies. I waive my right of access to any such information and without limitation hereby release the school district and the reference source from any liability in connection with its release or use. I understand a pre-employment physical examination and drug and alcohol tests may be required and that any offer of employment is conditioned upon results of my physical examination (including drug & alcohol screening if required) being satisfactory. Signature of Applicant Date Please feel free to include any attachments, resume or other information that you feel could be helpful in further describing your background and qualifications. Check your application! BE SURE YOU FILLED IT OUT COMPLETELY! Applications not signed will not be accepted. NOTICE OF NONDISCRIMINATION In accordance with Federal law and Morgan County R-II policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. file a complaint of grievance, contact the Title IX Director, Dr. L. Steven Barnes, 913 West Newton, Versailles, MO or call (573) The Morgan County R-II School District is an equal opportunity provider and employer. This employer will provide the Social Security Administration (SSA) and, if necessary the Department of Homeland Security (DHS), with information from each new employee s Form I-9 to confirm work authorization.