POLOR-VIISCHOOL DISTRICT

TEACHER APPLICATION

PLEASE FURNISH ALL REQUESTED INFORMATION ON THIS APPLICATION; DO NOT REFER TO OTHER SOURCES

Name:
(Last) / (First) / (Middle)
Current Address:
(Street/PO Box) / (City) / (State) / (Zip Code)
Telephone#
Permanent Address: (If different from above)
(Street/PO Box) / (City) / (State) / (Zip Code)
Telephone#
Please Indicate Which Position(s) Applying For:(Check as many as needed.)
Full-Time: / Elementary / Middle / Secondary
Part-Time: / Elementary / Middle / Secondary
Position Preference(s): / State clearly the kind of position for which the application is being made. Specify the subject(s) and/or grade(s) you desire to teach.
1st Preference:
2nd Preference:
3rd Preference:

Education Summary

Secondary School:
(Name of School) / (Address) / (Graduation Year)
Undergraduate School(s):
Name of College or University / Address
Dates Attended / Total Credits / Major Subject(s) / Credits in Major(s) / Minor Subject(s) / Credits in Minor(s) / Credits in Education / Degree / Degree Date
Graduate School(s):(Include Credits Earned Subsequent To Granting Of Bachelor’s Degree)
Name of College or University / Address
Dates Attended / Total Credits / Major Subject(s) / Credits in Major(s) / Minor Subject(s) / Credits in Minor(s) / Credits in Education / Degree / Degree Date
Student Teaching Experience:
Name & Address of School / Dates / Grade(s) or Subject(s) Taught / Credits / Name & Address of Supervisor / Name & Address of Cooperating Teacher
Professional Experience:
Name & Address of School / Dates / Number of Years / Full or Part Time / Salary / List Grade(s) and/or Subject(s) Taught, & Extra Curricular Activities Supervised
Other Significant Experience:(Assistantship, Travel, College Teaching, Tutoring, Substituting, etc.)
Experience & Location / Dates (Mo/Yr) / Number of Years / Full or Part Time
Personal References:Include local references, if possible. Only include those who are QUALIFIED to pass judgment on your qualifications for the position(s) you seek. These persons would need to have knowledge of your classroom work as a teacher or a college student (i.e., cooperation teacher, supervisor, department chair, principal, college supervisor, professors, etc.). Please list references even though they may be included elsewhere. Print legibly or type. Complete addresses must be included to be a valid reference.
Name / Address / Telephone#
Personal Data:
1) / Do you hold a valid State Teacher’s Certificate? / Yes or No. Which State?
If yes, what is the Title of Certificate?
2) / Are you now under contract? / Yes or No. Which school district?
3) / What is your current position?
4) / Reason(s) for desiring a change.
5) / If appointed to the staff are you willing to accept assignments to where your services are needed. / Yes or No
6) / What collegiate honors and awards have you received?
7) / In what collegiate activities have you participated?
8) / Are your credentials on file with a Placement Bureau? / Yes or No.
If yes, where? Please have them forwarded.
Please Check Appropriate Options Below:
I hereby authorize my current and former employers, and references to furnish any information about me and/or 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 the release.
I acknowledge that college transcripts will be needed by the state and school district.
I acknowledge that a criminal background check is required by the state to be certified. I will contact the school district to find out the procedures to get the check.
I affirm that the information provided on this form is true and correct.
I understand that any false statements could lead to dismissal if employed by the PoloR-VIISchool District.
I understand that my application will be kept on file in the district for one year, and must be resubmitted after that time for any new openings.
Additional Applicant Remarks, if any:

ALL APPLICANTS ARE URGED TO SUBMIT APPLICATION ONLY IF INTERESTED IN EMPLOYMENT AT THIS SCHOOL DISTRICT. MAIL OR FAX APPLICATION TO:

Superintendent’s Office
PoloR-VIISchool District
300 W. School St
PoloMO64671 / Tel# 660-354-2326
Fax# 660-354-2910 / The PoloR-VIISchool District does not discriminate on the basis of race, color, national origin, religion, ancestry, sex, disability, or age.
(Applicant’s Signature) / (Date)

Do not write below this line – For Administrative Use Only

Date Received: / Application / Credentials / Transcripts
Date Interviewed: / Interviewed By:
Date & Time Applicant Notified:
Date & Time Applicant Accepted:
Position Offered:
Salary Step & Level:

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10/18/2018