The Orrick R-XI School District, as an Equal Opportunity Employer, complies with applicable federal and state laws prohibiting discrimination, including Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973. It is the policy of the school district that no person, on the basis of race, color, national origin, sex, age, genetic predisposition, or handicap, shall be discriminated against in employment, educational programs and activities or admissions. Inquiries or complaints concerning the Orrick R-XI School District's compliance with the regulations implementing Title VI, Title IX or Section 504 may be directed to the Superintendent of Schools at the above address.

Personal Information

Date of Application *

First Name *

Middle Name

Last Name *

Present Address *

City *

State *

Postal Code *

Permanent Address (if not same)

City

State

Postal Code

Phone *

Email Address *

Availability

What is your present position? *

Are you now under contract? *

Present Contract Expiration Date

Date Available for Employment *

Position Desired

*

Elementary Teacher

Other Other

Extra duty positions you may be interested and capable of sponsoring or coaching:

Educational Preparation & Teaching Experience (if none, include student teaching experience)

Please submit a copy of your resume with a cover letter.

Current Employer *

May we contact? *

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Supervisor

Salary

Reason for Leaving

Please submit copies of your transcripts. *

References

Name *

Title *

Phone

Email Address

Name *

Title *

Phone

Email Address

Name *

Title *

Phone

Email Address

Please submit at least 3 letters of recommendation.

Certification

Missouri Certification Areas *

Grade Level (s) *

Please attach a copy of your Missouri Certificate of Teaching

Employment Questions

Are you legally authorized to work in the United States? *

Yes

No

Have you ever been arrested for, or charged with, or convicted of a felony or misdemeanor? (Exclude traffic offenses for which you were not sentenced to jail or for which the fine was less than $100). *

Yes

No

Have you ever pleaded guilty or no contest to a felony or misdemeanor? (Exclude traffic offenses for which you were not sentenced to jail or for which the fine was less than $100). *

Yes

No

Has the Missouri Children's Division or a similar agency in any other state or jurisdiction ever issued a determination or finding of cause or reason to believe or suspect that you have engaged in physical, emotional, psychological, or sexual abuse or neglect of a child? *

Yes

No

Have you ever been asked to resign or non-renewed from any educational institution? *

Yes

No

If the answer to any of the foregoing questions was "yes," please explain.

READ CAREFULLY BEFORE SIGNING

I acknowledge and agree to the following provisions as conditions to consideration of my application for employment.
1) I hereby authorize my current and former employers and references to furnish any information

about me and about my work experience. 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.
2) I understand and consent to having criminal and arrest records checks as well as background checks

by the Missouri Children's Division as a condition for consideration of my application for

employment.
3) I certify that the answers given in this application are true and complete to the very best of my

knowledge. In the event I am employed by the District and in the further event that I have provided

false or misleading information in this application or in subsequent employment interviews, I

understand that my employment may be terminated at any time after discovery of the false or

misleading information.
4) I understand if I choose to submit an electronic signature that it binds me as legally as my

handwritten signature.

Signature & Date *

clear

Agriculture	Art	Business
Driver's Education	Early Childhood	Elementary Education
Elementary Principal	English	Family & Consumer Science
Foreign Language	Heath	Journalism
Library Media Specialist	Mathematics	Music: Vocal
Music: Instrumental	Physical Education	Science: Biology
Science: Earth Science	Science: General	Science: Physics
Secondary Principal	Social Studies	Speech
Special Ed. Cross Categorical	SPED Director	Superintendent
Unified Science: Biology	Unified Science: Chemistry	Unified Science: Earth Science
Unified Science: Physics