Professional Application Form - McDonald County R-1 School District

Application
McDonald County R-1 School District
Anderson, Missouri
Application for Professional Employment
Date of application
Last Name
First Name
Middle Name
Address
City
State
Zip
Telephone
Emergency contact name:
and telephone:
Position Desired
If teacher or administrator, please indicate:
Level preferred: Mark first choice (1), second choice (2), etc.
Elementary Middle School Senior High School
If elementary teacher, complete:
Level preferred: Mark first choice (1), second choice (2), etc.
Kindergarten Primary (1-2) Intermediate (3-4) Middle (5-6)
If secondary teacher, complete:
Level preferred: Mark first choice (1), second choice (2).
Middle (7-8)
Senior High
List in order of preference the subjects you are certified to teach.
1. 2. 3.
If specialist, please check the area of specialization in which you are certificated and seek assignment.
Counselor Technology Media Specialist Instrumental Music Vocal Music
Special Education
Other:

List areas for which you have an interest to coach or sponsor:
Athletics:
Clubs or Organizations
(specify):
Personal Data
Social Security Number:
Missouri Retirement Number:
Have you ever failed to be re-employed
If yes, indicate where and
please state reasons.
Yes
No
Have you ever had a background check Yes No
Have you ever been convicted of a felony Yes No
Have you ever been involved in any incident regarding non-criminal child abuse which was substantiated and
documented by state social workers but not necessarily proven in court whether or not a criminal conviction of any
kind also occurred
Yes No, I have not been involved in such incident.
Present employment:
Position Location Annual Salary
Activities
Professional
Organizations:
Other:
Youth groups with
which you have worked:
Special Recognitions
Professional:
Other:

Certification
Missouri school law requires all teachers in Missouri Public Schools to hold a valid teaching certificate.
Do you hold a Missouri teaching certificate Yes No
Certificate type: IPC PCI PCII PCIII CPC LIFE
If you do not hold a Missouri teaching certificate, will you qualify for one by the opening of school Yes No
If you hold a temporary certificate, give date of expiration.
Please describe area(s) of certificate. Be specific.
Professional Preparation
Secondary education
School
Location
Undergraduate and graduate education
College or
University
Location
Attendance
Year to Year
Major
Degree
Semester
Hours
Total semester hours in education: Total semester hours in major field: Undergraduate GPA:
Graduate GPA:
Number of graduate hours earned since last degree was earned:
Please list college activities
in which you participated.
Student teaching experience
From
Month
Year
To
Month
Year
School City State
Grade and/or
subject
Name of cooperating teacher:

Non-teaching work experience:
Employer Location Type of Work Dates
Professional Experience
Total years teaching experience:
Total years teaching experience during past 10 years:
Years
Yr. to Yr.
Position School Name and Address Grade or Subject
Annual
Salary
Additional Information
Please state the reasons you are interested in this school district and further information which you believe may
strengthen your application.
If employed by the McDonald County R-1 Board of Education, I will support the school district's educational program,
rules and regulations. I certify that the information provided in the application is correct. I am aware that any false
statements are grounds for employment termination. I hereby authorize the McDonald County R-1 Board of Education
to examine local and state law enforcement agency records when considering my application for employment.
Please include two (2) letters of recommendation. Either e-mail them to swilliams@mcdonaldco.k12.mo.us
or mail to the address below.
Or print and mail to: Superintendent of Schools
McDonald County R-1 School District
100 Mustang Drive
Anderson, MO 64831
417-845-3321
The McDonald County R-1 School District does not discriminate on the basis of sex, race, creed, color, national origin or disability:
* In the recruitment, selection, treatment and promotion of employees;
* In the admission and participation of students in the educational programs or activities;
* In vocational opportunities