Richmond R-XVI School District
Richmond, Missouri
Application for Classified Staff
Instructions: Thank you for your interest in working for the Richmond R-XVI School District!
Please complete all information as accurately as possible. All files will be reviewed and, based on the
needs of the district, necessary interviews will be made with the selected candidates.
Background Information
Name: Social Security #:
Home Address:
City: State: Zip:
How long have you lived at your present address?
Home Phone: Cell Phone:
E-mail Address:
Are you legally eligible for employment in the United States? Yes No
(Proof of Citizenship or Immigration Status will be required for employment)
Position Applying For:
1. Full Time Part Time
2. Full Time Part Time
3. Full Time Part Time
How did you learn of this / these position(s)?
Have you ever worked for the Richmond R-XVI School District before? Yes No
If YES, when and your position:
Emergency Contact Name: Phone Number:
Yes No Have you ever been convicted of a misdemeanor or a felony?
Yes NoHave you been convicted of any violation of the law other than minor traffic
offenses?
Yes NoAre you currently or have you anytime in the past been on parole or probation?
Yes NoHave you ever been released, terminated or resigned from school-related
employment because of misconduct or unsatisfactory service?
Yes NoAre you the subject of a current or pending investigation by Children's Division or an investigation concerning you has been completed but results are still pending?
If you answered yes to any of the above questions, please write an explanation here:
Education
Please list your last two schools of attendance:
1. Name of school:
Dates Attended:
Graduated: Yes No
2. Name of school:
Dates Attended:
Graduated: Yes No
Please list any degrees, certificates, training or special knowledge / skills that you have and would help you in this position:
Work Experience
Please list your last three employers starting with your most current position:
1. Name of Employer:
Address:
Job Title:
Supervisor:
Dates: From To
2. Name of Employer:
Address:
Job Title:
Supervisor:
Dates: From To
3. Name of Employer:
Address:
Job Title:
Supervisor:
Dates: From To
References
Please list the names of three persons who are not related to you but are familiar with your work experience and qualifications.
1. Name:
Address:
Phone Number:
2. Name:
Address:
Phone Number:
3. Name:
Address:
Phone Number:
Verification Statement
The information in this Application for Classified Staff employment is true, correct and complete to the best of my knowledge. I certify that I have answered all questions to the best of my ability and I have not withheld any information that would unfavorably affect my application for employment. I acknowledge that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews, may be the cause for my rejection from employment or may result in subsequent dismissal if I am hired. I hereby authorize the Richmond R-XVI School District to examine local and state law enformcement agencies, criminal records agencies, former employers, education institutions, Missouri or other State Department of Social Service, and/or Child Protective Services when considering my application for employment. I waive my right of privacy to any such information and hereby release the school district and reference sources from any liability in connection with the information. Furthermore, it is understood that this application becomes the property of the Richmond R-XVI School District.
Signature: Initials: Date:
By entering your name and initials, you electronically approve the above document.
The Richmond R-XVI School District is an equal opportunity employer and does not discriminate or deny services on the basis of age, ancestry, color, disability, handicapping condition, marital status, national origin, parental status, race, religion, participation in constitutionally protected activities, or veteran status. Any questions regarding Title IX, Section 504, The Family Medical Leave Act, or The Americans with Disabilities Act should be directed to the Superintendent of Schools at the below address and telephone number. If special needs exist as addressed in the Americans with Disabilities Act which require this publication in an alternative format, the district may be contacted at the above address. Reasonable effort will be made to accommodate these special needs.
Please mail or email this completed application, and any supporting materials to:
Richmond R-XVI School District
Classified Employee Search
1017 East Main Street
Richmond, MO 64085
(April Green – Secretary to the Board of Education)
(816) 776-6912
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