ࡱ> |~{!` bjbj\\ 4x>>+++++T29--------8888888$9hP<l83--338--8]3]3]33 --8]338]3]3]3-, y-X+!3 ]339029]3<+3(<]3<]3@-.]3/n0---88S3 ---293333%++  Stockton Public School PO Box 190 Stockton Missouri 65785 CERTIFIED PERSONNEL APPLICATION Please furnish all information requested on this application, do not refer to other sources. Date of Application _______________ Date Available _______________ Name ________________________________________________________________ Last Name First Name Middle Initial Present Address ______________________________________________________ Street/PO Box City State Zip Tel # Permanent Address ____________________________________________________ Street/PO Box City State Zip Tel # Email Address _________________________________________________________ Position for Which Application is Made 1st Choice 2nd Choice 3rd Choice An Equal Opportunity Employer The District does not discriminate against any applicant, employee or student on the basis of race, creed, national origin, marital status, handicap, or sex. For Office Use Only Assignment __________________ Effective Date _______________ Step __________ Degree ________ Base Salary _________________ Extra Duties ____________________________________________________________ Total Salary __________________ Certification Missouri Certification _______________ Level __________ Expiration Date __________ _______________ Level __________ Expiration Date __________ _______________ Level __________ Expiration Date __________ Out of State Certification _____________________________________________________ Educational and Professional Training Name of School or InstitutionDegree or DiplomaDates High School  NA College or University  College or University  College or University  Undergraduate Major _________________________ Minor ____________________ Graduate Major ______________________________ Graduate Hours ___________ Student Teaching Name of District, School & CityGrades/SubjectsDates  Teaching Experience Name of District, School & CityGrades/SubjectsDates        Present Salary _____________ for __________months Salary required ___________ List any activities you are willing and qualified to sponsor. (example: Basketball, Drama) 1. ______________________________ 2. ______________________________ 3. ______________________________ 4. ______________________________ Have you ever been convicted of a felony? __________ If yes, please explain below. Would you object to a criminal background check being done? __________ In the space provided below, in your own handwriting, please provide any additional information that will help us to know you better. Include special preparation, your philosophy of education, etc. If additional space is needed attach and sign a letter.  Experience Other Than Teaching Name of Firm & LocationType of WorkDates     Note: All time must be accounted for. References Five references are required for employment, including superintendents, principals, or supervisors under whom you have taught and who have first hand knowledge of your character, personality, scholarship and teaching ability. NameOfficial PositionAddress/Telephone     I certify that the facts set forth in this application are true and complete, and I hereby authorize Stockton School District to collect information concerning my character, personality, scholarship and general teaching ability. I hereby release prior employers, including school districts, from liability and authorize same to furnish any information about me and my work performance, including but not limited to discipline records and performance evaluations. I understand that false statements employed in this application may be considered sufficient cause for dismissal. ___________________________________________ Signature/date Minimum Preparation: A bachelors degree is required for placement in Stockton Schools and an advanced degree may be required in some areas. Certification: A degree certificate issued by the Missouri State Board of Education. Applicants should communicate with Teacher Certification, Department of Elementary and Secondary Education, PO Box 480 Jefferson City, MO 65101. Salary Schedule: Teachers are placed on the salary schedule according to Board policy, training and experience. Transcript: In case of appointment it will be necessary to submit an official transcript. Applications are kept on file for a period of six (6) months from the Date of Application. Return Application to: Dr. Vicki R. 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