Windsor C-1 School District Is an Equal Opportunity Affirmative Action Employer

Windsor C-1 School District is an equal opportunity affirmative action employer

Please answer all questions in detail. Indicate NA or “none” where applicable. False, incomplete or inaccurate information is cause for disqualification or discharge. Windsor C-1 School District does not discriminate on the basis of race, color, religion, sex or national origin and persons with disabilities who, with reasonable accommodation, can perform the essential functions of a job. EMPLOYMENT IS CONTINGENT UPON A SUCCESSFUL STATE AND FEDERAL CRIMINAL HISTORY RECORD INFORMATION CHECK BASED ON A FINGERPRINT SEARCH AND A SUCCESSFUL DIVISION OF SOCIAL SERVICES – CHILDREN’S DIVISION CHILD ABUSE AND NEGLECT RECORDS CHECK.

Personal Information

Please Type or Print Clearly

Application Date

Last NameFirstMiddleLast four SSN Number

Present Address

Permanent Address

______If no phone, where can we contact you?

HomePhone

Email Address(Optional)

Position(s) Desired

Administrative position:

classroom position (List grade levels/subject areas in order of preference)

Elementary / Middle School (6-8) / High School (9-12) / Special Education

Other position(s) in which you are interested:

____ Counseling____ Early Childhood (Pre-K)____ Early Childhood Special Education

____ Occupational Therapist____ Physical Therapist____ Psychological Examiner/Diagnostician

____ Speech Language Pathologist____ Classroom Para____ Substitute Teacher

Certification

Do you hold a Missouri Teachers Certificate? ____Yes ____No

List below current Certification Areas held.

Areas or Subjects / Grade Level / Type of Certificate / expiration date

Indicate Certification held from another state if applicable:

Educational Preparation

High
School / Name / address / Total
Semester Hours
Credit
Colleges
and/or
Universities / Name of Institution / Address of Institution / Degree / Under
Graduate / Graduate

Teaching Experience

List in sequence most recent experience first and account for each school year since you began teaching. Indicate student teaching but omit substitute teaching.

Inclusive
Dates / Years
of
exp. / Name of School / Address
and
Phone / Subject or
Grades
taught / Full or
part
time / Reason
For
Leaving
From / To

Non-Teaching Experience

List related work, which would enhance your professional performance

Inclusive
Dates / Years
of
exp. / Name and Address of Organization / Position / Name of Supervisor / Reason
For
Leaving
From / To

Have you ever been employed by the Windsor C-1 School District in any capacity? ___Yes___No

If yes, please explain in what position and in what years?

References

These should be persons qualified to answer questions about your qualifications or the position you seek. Include Superintendents and principals under whom you have taught, or professors with whom you have studied. Indicate any that are related to you.

Name / Title / Address / Telephone

Activities, Special Interests and Awards

College activities and honors

Professional organizations to which you belong

Community organizations and activities in which you have participated in (youth work, service clubs, etc.)

Hobbies and outside interests

Travel experience

Elementary Candidates – circle those activities you can perform as a part of the program of self-contained classroom: sing, play piano, teach music, teach art, direct plays. List others:

MS/HS Candidates – circle those activities which you can direct successfully: debate, school plays, speech activities, yearbook, newspaper, student council, baseball, basketball, cross country, football, soccer, softball, tennis, track, volleyball, wrestling, cheerleaders, pom pons, pep club, community education activities. List others:

What extracurricular activities would you consider directing?

Student Teaching/Internship

Name of School: Date Address:

District: Cooperating Teacher:

Assignment (Subject and Grades): Grade Received:

Professional Statement

Please write a brief statement, in your own handwriting, to the statements below.

Why did you choose teaching as a career?

If you were employed as a teacher in the Windsor C-1 School District, what skills and personal qualities would you bring to your assignment to assure a successful teaching experience?

Applicants Statement/Authorization for Investigation

I hereby affirm that my answers to the foregoing questions on this application are true and correct, and that I have not knowingly withheld any fact or circumstance that would if disclosed, affect my application unfavorably. I understand that any false information, intentional omissions or misrepresentations submitted on this application are cause for dismissal or non-renewal of contract, and also that a satisfactory State and Federal criminal history records information check based on a fingerprint search and a Division of Social Services – Children’s Services Division child abuse and neglect records check are required for employment and continuation of employment.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including, but not limited to, criminal conviction records, motor vehicle driving records, Division of Family Service records and information from references, schools and employers listed in the application. I hereby release to Windsor C-1 School District, its designees and all agencies, references, schools and employers from all liability from any damage that may result from providing information about my prior employment to the Windsor C-1 School District.

In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I also understand that I am required to abide by all rules and regulations of the policies approved by the Board of Education of the Windsor C-1 School District.

Signature of ApplicantDate

Criminal Records Check/Child Abuse Neglect Report

Employment with the Windsor C-1 School District is contingent upon the satisfactory completion of a criminal record and a child abuse/neglect record check. The Windsor C-1 School District reserves the right to evaluate information from all sources and determine whether or not an applicant shall be advanced in the selection process. If an offer of employment, contract, or letter has been issued, prior to receipt of any negative report or reports and such report or reports, in the judgment of the Board of Education is unsatisfactory, said employee shall be immediately terminated. Any contract issued in association with employment shall be considered NULL and VOID. READ THE FOLLOWING QUESTIONS VERY CAREFULLY. FAILURE TO ANSWER ALL QUESTIONS COMPLETELY AND ACCURATELY MAY LEAD TO TERMINATION OF EMPLOYMENT FOR DECEPTION/FALSIFICATION ON YOUR APPLICATION.

Have you ever been arrested for, charged with or convicted of a felony, misdemeanor, or ordinance violation? (Exclude traffic offenses for which you were not sentenced to jail or for which the fine was less than $100.00. INCLUDE offenses related to driving while intoxicated (DWI) or driving while under the influence (DUI).)