Name Last First Middle. Address Street City State Zip. Phone ( ) ( ) ( ) Home Work Mobile

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1 Application Lamar R-1 School District Lamar, Missouri Application for Professional Employment Please type or use ink. Date of application Name Last First Middle Address Street City State Zip Phone ( ) ( ) ( ) Home Work Mobile Position Desired: Elementary Middle School Senior High School If elementary teacher, complete: Kindergarten Primary (1-2) Intermediate (3-4) Middle School (5-6) If secondary teacher, complete: Middle (7-8) Senior High (9-12) List in order of preference the subjects you are certified to teach: If specialist: Please check the area of specialization in which you are certified and seek assignment. Counselor Technology Media Specialist Instrumental Music Vocal Music Special Education (specify type) List areas for which you have an interest to coach or sponsor: Athletics Clubs or organizations (specify)

2 Personal Data Social Security number Missouri retirement number Have you ever failed to be re-employed Yes No If yes, indicate where and please state reasons Have you ever been convicted of a felony? Yes No If yes, please explain Have you been involved in any incident regarding non-criminal child abuse which was substantiated and documented by state social workers but not necessarily proven in court whether or not a criminal conviction of any kind also occurred? Yes No Present employment Activities $ Position Location Annual Salary Professional organizations Other Youth groups with which you have worked Special recognitions Professional Other 2 Page

3 Certification Missouri school law requires all teachers in Missouri Public Schools to hold a valid teaching certificate. Do you hold a Missouri teaching certificate? Yes No Certificate type: PCI PCII PCIII CPC LIFE If you do not hold a Missouri teaching certificate, will you qualify for one by the opening of school? Yes No If you hold a temporary certificate, give date of expiration Please describe area(s) of certificate. Be specific. Professional Preparation Secondary education School Location Graduated Yes No Undergraduate and graduate education College or University Location Major Degree Semester Hours Total semester hours in education Total semester hours in major field Undergraduate GPA Graduate GPA Number of graduate hours earned since last degree was earned Please list college activities in which you participated 3 Page

4 Student teaching experience From To Mo. Yr. Mo. Yr. School City State Grade and/or subject Name of cooperating teacher Non-teaching work experience Employer Location Type of work Dates Professional Experience Total years teaching experience Total years teaching experience during past 10 years Years Position School name, address, & phone number Grade or subject Annual Salary 4 Page

5 If employed by the Lamar R-1 Board of Education, I will support the school district s educational program, rules and regulations. By signing this application for employment, I agree to allow the Lamar R-1 School District administration to check my criminal record, references, and credit history. I also verify that all of the information I have stated above is true and accurate. I understand that if any of the information provided in this application is found to be untrue or misrepresented, that will be grounds for immediate dismissal from employment with the Lamar R-1 School District. Applicant s signature The applicant must file with the personnel office official transcripts of college and university credit earned and a copy of placement papers including at least three letters of reference (include at least one letter from your principal or other persons familiar with your teaching experience). An application may be renewed by contacting the personnel office. Please return completed application to: Superintendent of Schools Lamar R-1 School District 202 West 7th Lamar, Mo The Lamar R-1 School District does not discriminate on the basis of sex, race, creed, color, national origin or disability: In the recruitment, selection, treatment, and promotion of employees; In the admission and participation of students in the educational programs or activities; In vocational opportunities; In the treatment, counseling, and placement of students. 5 Page