North Harrison R-III School District

Administrative Office
12023 Fir Street
Eagleville, Missouri 64442
Phone: 660-867-5222
Employment Application Fax: 660-867-5263

Applicant Information
It is the policy of the North Harrison R-III School District to provide equal employment opportunity regardless of race, religious creed, national origin, disability, sex, or age.

Full
Name:                 Date:      
Last First M.I.
Address:            
Street Address Apartment/Unit #
                 
City State ZIP Code
Phone: (     )       E-mail Address:      

Date Available:       Social Security No.:      

Position Desired

List grades and/or subjects in order of preference.

Elementary      
Middle School      
High School      
Other      

Present position, occupation, or status:      

Expiration date of present contract:      

Name and address of placement bureau where credentials are on file:      

Are you available for a personal interview? YES NO Preferred day and time:      
Student Teaching Experience
Supervising Teacher:      
Level/Subject Area:       Date:       Place:      

Qualifications
Complete the items in this section only if the information does not appear on your resume.
Do you hold a valid Missouri Certificate? YES NO

Levels and areas of certification:      

List any out of state certificates:      
High School, college, or professional honors or recognition:      

Experience with youth organizations or working with children:      

Total years teaching experience in elementary:       Middle:       High School:      

If currently employed, state reason for leaving present

position:      

Present annual salary:       Expected salary:      

Are you willing to complete your share of extra-classroom duties? YES NO

List duties or obligations that would interfere with your accepting any assignment, attending meetings, or participating in
activities outside regular school hours:

     

Elementary candidates – List school clubs or after school activities you could supervise:      

Secondary candidates – Check the activities you can direct, coach, or supervise:

Debate Student Council Track Volleyball

Public Speaking Pep Club Wrestling School Plays
Cheerleaders Softball School Newspaper Football
Golf Yearbook Basketball Other

List experience or training with the following:

Cooperative Learning:      

Inquiry-Based Instruction:      

GLE Based Curriculum Development:      

eMINTS Professional Development:      

Technology Based Instruction:      

Reading Correction:      

SmartBoards:      

Classroom Management Strategies:      

Why did you choose education as your profession? (Please limit to 250 words or less.)
     

Applicant’s Statement

Applicant Statement portion of the district application must contain an original signature and
should be mailed or faxed to the district office.

Please read this statement carefully before signing.

It is the policy of the North Harrison R-III School District to provide equal employment
opportunity regardless of race, religious creed, national origin, disability, sex, or age.

1. I hereby authorize my current and former employers to furnish any information about
me and my work experience.
2. I understand and consent to having a criminal and arrest records checks as well as
background checks as a condition and consideration of my application for employment.
In accordance with Missouri law, this background check will include a complete fingerprint
criminal records check.
3. I certify that the answers given in my application packet are true and complete to the
best of my knowledge. I also understand that, even if employed, falsified statements on
my application or during interviews shall be grounds for termination of employment.
4. I acknowledge that my employment is contingent upon the District’s receipt of a clean
criminal background check and child abuse/neglect report, each of which must be
satisfactory to the District.

_____________________________ _________________
Applicant’s signature Date