To Learn More About the Grain Valley R-V School District

Grain Valley R-5 School DistrictSubstitute

P.O. Box 304Teacher

Grain Valley, MO 64029Application

(816) 847-5006

TO LEARN MORE ABOUT THE GRAIN VALLEY R-V SCHOOL DISTRICT

LOG ON TO: WWW.GRAINVALLEY.K12.MO.US

OUR EQUAL OPPORTUNITY POLICY

The Grain Valley R-5 School District is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.

INSTRUCTIONS: It is very important to provide complete and accurate information on this application. You may also attach a resume, or separate sheets of paper as needed, which will become part of this application.

PERSONAL

Name:Last: First: MI: / Date:
Street Address:
City: State: Zip: / Email Address:
Primary Phone: / Type: / Social Security Number:
Alt. Phone: / Type: / Graduate/Undergraduate Hours
How were you referred?
Walk-In Current Employee : Newspaper/Publication:
Website: Other:
Do you hold a current Missouri Certification?
Yes No / If yes, provide field of certification:
Are you a member of the Missouri Public School Retirement System? Yes No / If yes, are you currently receiving a benefit?
Yes No
What is your grade level preference? / What days are you available to substitute?
Monday Tuesday Wednesday
Thursday Friday
Would you be willing to substitute in Special Education? Yes No / What time are you available to substitute?
AM PM All Day

EDUCATION

Schools Attended
Past and Present / Names and Locations of Schools / No. of years / Did you graduate? / Major / Degree earned
High School
College
Post-Graduate Work
Other Education and Training

WORK EXPERIENCE

List chronologically last 5 years, beginning with most recent employment. PLEASE NOTE: your application will not be processed if you write in “See Resume.”

Company Name and Address / Dates of Employment / Position Held / Reason for Leaving
From: / Starting:
To: / Ending:
Job Duties:
Company Name and Address / Dates of Employment / Position Held / Reason for Leaving
From: / Starting:
To: / Ending:
Job Duties:
Company Name and Address / Dates of Employment / Position Held / Reason for Leaving
From: / Starting:
To: / Ending:
Job Duties:
Company Name and Address / Dates of Employment / Position Held / Reason for Leaving
From: / Starting:
To: / Ending:
Job Duties:

REFERENCES

Please list two personal and three professional references, not related to you, whom we can contact.

Name / Relationship / Job Title/Company / Phone Number

General Information

List other information you would like to include as an indication of your teaching abilities.
Have you applied for substituting in another district?
Yes No / If yes, what district:

Agreement: I hereby certify to the best of my knowledge that the above information is true, accurate, and complete. I understand that any misrepresentation or willful omission of facts shall be sufficient cause for disqualification or termination of my employment with the Grain Valley R-5 School District. I hereby authorize the District to conduct a background investigation and authorize the release of information in connection with my application for employment. 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 this release.

Signature of Applicant: ______Date: ______

Electronic Signature: Date:

(Please print if submitting electronically)

Remember to apply for your substitute certificate through the Dept. of Elementary and Secondary Education at www.dese.mo.gov