JOEL E. BARBER C-5 SCHOOL DISTRICT CERTIFIED APPLICATION 16050 Highway KK Lebanon, MO 65536

APPLICATIONS NOT FILLED OUT COMPLETELY WILL NOT BE CONSIDERED.

Position applied for: ______Date of Application: ______

Applicant: ______S.S. #: ______

Address: ______Telephone: ______

To your knowledge, are you related to any employees or school board members of the school district? Yes: ____ No: ____ If yes, explain: ______

-EDUCATIONAL BACKGROUND-  You must have a valid teaching certificate for this position.  Please list all education chronologically, beginning with the high school from which you graduated. Fill in all spaces.

School/College: Location: Dates of Attendance: Degrees Earned: Hours Earned: ______

GRADE POINT AVERAGE: Bachelor’s: ______Master: ______Spec/Doctorate: ______

-WORK EXPERIENCE IN SCHOOLS-  You must have a high school diploma or equivalent to be eligible for this position.

School: Location: Job Title: Dates: Responsibilities: ______

-ADDITIONAL WORK EXPERIENCE- Location: Job Title: Dates: Responsibilities: Supervisor: ______

The Joel E. Barber C-5 School District does not discriminate based on race, gender, national origin, disability, or age. Persons who have questions about this may inquire at the Superintendent’s Office, 16050 Hwy. KK, Lebanon, MO 65536 or telephone: (417) 532-4837. The Joel E. Barber School District is an equal opportunity employer. 05/01/2011 ______

-QUALIFICATIONS- Describe any experiences, skills, or qualifications, which you feel would especially qualify you to become employed as an aide in the classroom: ______

-REFERENCES- Please list:  2-3 persons who have directly supervised your work  2-3 persons who have known you for one or more years

Name: Supervisor/Friend: Address: Telephone: ______

-ADDITIONAL INFORMATION- 1. Areas of teaching in which you hold a current Missouri certificate: ______

2. Areas of interest you have regarding the education of children: ______

3. List professional development activities in which you have participated during the last two years: ______

4. Have you ever been charged with or convicted of child abuse or child molestation? Yes: ____ No: ____ If yes, please explain. ______

5. Have you ever been convicted of a felony? Yes: ____ No: ____ If yes, please explain. ______The Joel E. Barber C-5 School District does not discriminate based on race, gender, national origin, disability, or age. Persons who have questions about this may inquire at the Superintendent’s Office, 16050 Hwy. KK, Lebanon, MO 65536 or telephone: (417) 532-4837. The Joel E. Barber School District is an equal opportunity employer. 05/01/2011 ______

6. List any other criminal history involving an arrest, DWI, DUI, Pleas of nolo contendore (no contest), Alford pleas, or any other misdemeanor offense. ______

7. Has any offense been “expunged” (removed) from your record? Yes: ____ No: ______

8. Have you ever been issued a “suspended imposition of sentence” for any felony or misdemeanor? ______

9. Please explain any previous separation of employment, remedial action, or disciplinary procedures taken against you by a previous employer. None: ____ If so: ______

-Essay Responses- Please answer the following questions on separate pages:

1. In your own handwriting, describe what your personal and professional goals are and how you intend to attain them. 2. What are the most important characteristics of an effective teacher? Please explain why each characteristic is important. (Answer for the position for which you are applying and please type your answer.) 3. Describe your training and/or experience with the following by typing your answers:  Use of Technology personally and as a classroom resource  Implementing an integrated curriculum  Delivering instruction for active learning

To complete you application, please include a resume, a copy of your Missouri Teaching Certificate, current transcript, if appropriate, and any other pertinent materials you feel might help to substantiate your qualifications.

 The school district will complete a criminal background check including all convictions and/or child abuse charges on all candidates. Please provide your signature indicating your authorization for this background check.  I understand that providing any false information in this application constitutes fraud, and I hereby certify I have answered accurately and completely all questions in this application.

The Joel E. Barber C-5 School District will complete a background check including all convictions and/or child abuse charges on all candidates. Your signature below authorizes us to conduct such a background check.

______(Full Name) (Date)

The Joel E. Barber C-5 School District does not discriminate based on race, gender, national origin, disability, or age. Persons who have questions about this may inquire at the Superintendent’s Office, 16050 Hwy. KK, Lebanon, MO 65536 or telephone: (417) 532-4837. The Joel E. Barber School District is an equal opportunity employer. 05/01/2011 Please return to: Tina Nolan

Superintendent of Schools Phone: (417) 532-4837 Joel E. Barber C-5, Laclede County Fax: (417) 588-2100 16050 Highway KK Email: [email protected] Lebanon, MO 65536

The Joel E. Barber C-5 School District does not discriminate based on race, gender, national origin, disability, or age. Persons who have questions about this may inquire at the Superintendent’s Office, 16050 Hwy. KK, Lebanon, MO 65536 or telephone: (417) 532-4837. The Joel E. Barber School District is an equal opportunity employer. 05/01/2011