Mountain View School District

210 High School Drive Phone: (870)269-3443

Mountain View, AR 72560 Fax: (870)269-3446

CLASSIFIED APPLICATION

Date

PERSONAL INFORMATION

(Last Name) (First Name) (Middle Name)

Address (Street) (City/State) (Zip)

Phone Number: / Cell Phone:
Position Desired:

(If Position Desired is Substitute Teacher, please mark campuses where you would be willing to work:)

Mountain View Elementary School Mountain View Middle School

Mountain View High School Rural Special Elementary School

Rural Special High School Timbo Elementary School

Timbo High School ALL SCHOOLS

Have you been previously employed by this district? No Yes

If Yes, when?

Do you have any physical/medical impairment that would interfere with your performance in the position for which you are applying? No Yes

Condition of health for the past two years:

When could you begin to work here?

Have you ever been convicted of a felony: No Yes

If Yes, please explain

Have you ever been convicted of a misdemeanor other than a traffic violation: No Yes

If Yes, please explain


(If Position Desired is Bus Driver, provide the following information:)

Commercial Driver’s License Number

Have you driven a bus before? No Yes

If Yes, where and when?

Have you ever had your driver’s license suspended? No Yes

If Yes, please explain

EDUCATION AND PROFESSIONAL TRAINING

(High School) (Date) (Degree or Diploma)

(Vocational School/College) (Date) (Degree or Diploma)

(Other) (Date) (Degree or Diploma)

(Other) (Date) (Degree or Diploma)

WORK EXPERIENCE (Please list three, if possible)

Name and Address of Employer
Dates worked / From: / To:
Type of Work
Name and Address of Employer
Dates worked / From: / To:
Type of Work
Name and Address of Employer
Dates worked / From: / To:
Type of Work


MILITARY SERVICE

Branch of Service
Inclusive Dates / From: / To:
Rank or Position Held

REFERENCES

Name
Address
Phone
Official Position
Name
Address
Phone
Official Position
Name
Address
Phone
Official Position
Name
Address
Phone
Official Position

I authorize investigation of all statements contained in this application. I understand misrepresentation, falsification, or omission of facts called for is cause for dismissal without notice at any time during my employment. I also understand that some jobs require special background checks prior to my employment and that failure to meet these requirements may lead to my rejection as an applicant for that job.

I agree, if employed, to follow all rules and regulations of the district. I agree to promptly notify the district of any change of address during my employment. I certify that the information given by me in this application is true and correct without omissions of any kind.

Signature of Applicant ______