ORAN R-III SCHOOL DISTRICT



5812155-64770Rev. 09/01/201600Rev. 09/01/2016SUBSTITUTE TEACHING APPLICATIONORAN R-III SCHOOL DISTRICT310 CHURCH STREET P.O. BOX 250ORAN, MO 63771573-262-2330 (Option 4)FULL NAME: _______________________________________ DATE: _______________________PRESENT ADDRESS: ____________________________City __________________ State_________ Zip_________PERMANENT ADDRESS: ____________________________City __________________ State_________ Zip_________ (Where W-2 can be mailed)PHONE NUMBER: ______________________ CELL PHONE#: ________________________GRADES PREFERRED (check all that apply): _______ K-6 ________ JH ________HSDAYS OF THE WEEK AVAILABLE: ___________________________________________________PLEASE CHECK ONE SUBSTITUTE CATEGORY: _____Regular Sub (60 hours or more) ____ Career Education (Based on work and/or college experiences) _____Educator (with MO Teaching Certificate)TOTAL NUMBER OF SEMESTER HOURS: ______________ DEGREE: ____Yes ____NoMAJOR: ________________________________ MINOR: __________________________________SOCIAL SECURITY #: _________________________ BIRTHDAY:__________________________RACE:_______________ Is English your first Language: ___Yes ___No Are you of Latino descent: : ___ Yes ____No (Optional)ARE YOU A RETIRED TEACHER: ____Yes ____No (If yes, which state): ___________________ ARE YOU A MEMBER OF PSRS (Missouri School Retirement System): ____Yes ____No COLLEGES ATTENDED: ________________________________________________________________________________________________________________________________________________571546355Before you can be added to our sub list, you must go online to machs.mshp.dps. and apply for Fingerprinting/background check.If you do not have a Substitute Certificate, AFTER you are fingerprinted go to dese. (Department of Elementary & Secondary Education) and apply for Substitute Certificate. You will need to complete an Educator Profile in order to do this.When Substitute Certificate is available, please print it off and bring or mail a copy to our office.We also need a copy of your Driver’s License and Social Security CardAdditional papers will be needed before you can be added to sub list. These papers can be obtained from the central office: I-9; W-4 (MO & Federal); Highway Patrol Child Abuse form; etc.00Before you can be added to our sub list, you must go online to machs.mshp.dps. and apply for Fingerprinting/background check.If you do not have a Substitute Certificate, AFTER you are fingerprinted go to dese. (Department of Elementary & Secondary Education) and apply for Substitute Certificate. You will need to complete an Educator Profile in order to do this.When Substitute Certificate is available, please print it off and bring or mail a copy to our office.We also need a copy of your Driver’s License and Social Security CardAdditional papers will be needed before you can be added to sub list. These papers can be obtained from the central office: I-9; W-4 (MO & Federal); Highway Patrol Child Abuse form; etc. (Continue on next page) (See reverse side)PREVIOUS WORK EXPERIENCE: Company/School: ____________________________Phone: _______________________City/State: ________________________________ Supervisor: _______________________ Dates: ____________________________________ Company/School: ____________________________Phone: _______________________City/State: ________________________________ Supervisor: _______________________ Dates: ____________________________________REFERENCES: (Not Relatives) Name: ________________________________ Phone: ________________________ Occupation:_____________________Address: _____________________________________________________________________________________________ Name: ________________________________ Phone: ________________________ Occupation:_____________________Address: _____________________________________________________________________________________________ Name: ________________________________ Phone: ________________________ Occupation:_____________________Address: _____________________________________________________________________________________________ Have you ever been found guilty or been convicted of any criminal act in this state or any state? _____________If yes, please give date, city/county/state & circumstance: _________________________________________________________________________________________________________________________________________________I recognize that falsification of this applicationwill result in my dismissal!!!_____________________________________Signature of Applicant (can be typed if submitting online)Mail completed form to: Oran R-3 Schools orEmail to: mscherer@oran.k12.mo.us P.O. Box 250 Oran, MO 63771 Questions, call 573-262-2330 ext. 301The Oran R-III School District does not discriminate, either in employment or in its offerings for students, on the basis of race, color, national origin, sex, age, or handicap. Inquiries concerning compliance with the regulations Implementing Title VI, Title IX, or Section 504, P.L. 93-112, are directed to contact Title IX/Section 504 Coordinator, Oran R-III School District, 310 Church Street, Oran, MO. 63771. Phone (573) 262-3345. ................
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