SUBSTITUTE TEACHING APPLICATION

ORAN R-III SCHOOL DISTRICT

310 CHURCH STREET P.O. BOX 250

ORAN, MO 63771

573-262-2330 (Option 4)

FULL NAME: ______DATE: ______

PRESENT ADDRESS: ______City ______State______Zip______

PERMANENT ADDRESS: ______City ______State______Zip______

(Where W-2 can be mailed)

PHONE NUMBER: ______CELL PHONE#: ______

GRADES PREFERRED (check all that apply): ______K-6 ______JH ______HS

DAYS OF THE WEEK AVAILABLE: ______

PLEASE CHECK ONE SUBSTITUTE CATEGORY: _____Regular Sub (60 hours or more) ____ Career Education (Based on work and/or college experiences) _____Educator (with MO Teaching Certificate)

TOTAL NUMBER OF SEMESTER HOURS: ______DEGREE: ____Yes ____No

MAJOR: ______MINOR: ______

SOCIAL SECURITY #: ______BIRTHDAY:______

RACE:______Is English your first Language: ___Yes ___No Are you of Latino descent: : ___ Yes ____No

(Optional)

ARE YOU A RETIRED TEACHER: ____Yes ____No (If yes, which state): ______

ARE YOU A MEMBER OF PSRS (Missouri School Retirement System): ____Yes ____No

COLLEGES ATTENDED: ______

______

(Continue on next page)

(See reverse side)

PREVIOUS WORK EXPERIENCE:

Company/School: ______Phone: ______

City/State: ______Supervisor: ______

Dates: ______

Company/School: ______Phone: ______

City/State: ______Supervisor: ______

Dates: ______

REFERENCES: (Not Relatives)

Name: ______Phone: ______Occupation:______

Address: ______

Name: ______Phone: ______Occupation:______

Address: ______

Name: ______Phone: ______Occupation:______

Address: ______

Have you ever been found guilty or been convicted of any criminal act in this state or any state? ______

If yes, please give date, city/county/state & circumstance: ______

______

I recognize that falsification of this application

will result in my dismissal!!!

______

Signature of Applicant

(can be typed if submitting online)

Mail completed form to: Oran R-3 Schools or Email to:

P.O. Box 250

Oran, MO 63771 Questions, call 573-262-2330 ext. 301

The Oran R-III School District does not discriminate, either in employment or in its offerings for students, on the basis of race, color, national origin, sex, age, or handicap. Inquiries concerning compliance with the regulations Implementing Title VI, Title IX, or Section 504, P.L. 93-112, are directed to contact Title IX/Section 504 Coordinator, Oran R-III School District, 310 Church Street, Oran, MO. 63771. Phone (573) 262-3345.