KIRKWOOD SCHOOL DISTRICT
Excellence in Education Since 1865  
Employment Application for Substitute Staff
11289 Manchester Road, Kirkwood, MO 63122

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* Last Name:
* First Name:
Middle Name:
All Other Names Formerly Used:
* SSN: (Ex: xxx-xx-xxxx)

Present Address
Street Address:
City:
 State:
Country:
Zip Code:
* Home Phone:
Email:
*Work Phone:
Ext:

*Position(s) Desired:Sub TeacherSub Walking CounselorSub Nurse
 Sub Office PersonnelSub Early Childhood CenterSub Assistant
Grade Levels and Subjects Willing to Work:(Check all that apply)
Pre-KindergartenArtForeign LanguageMusic Education
K-5Business EducationHome EconomicsPhysical Education
6-8Drama/SpeechIndustrial TechnologyScience
9-12EnglishMathematicsSocial Studies

Date of Availability: ex: dd/mm/yyyy  |  Pay range expected: $

Special training or skills:


Do you hold a valid Missouri Teaching Certificate? Yes No
If no, how many college credit hours do you have? 60-119 hours 120 or more hours

Do you meet the legal minimum age requirement for employment? Yes No

Each question has a 150 character limit. Please attach additional papers if more information is needed.
1. Have you been investigated by the Division of Family Services for child abuse or neglect?
Yes No If yes, describe in full.
    
2. Have you ever been convicted of a violation of any federal, state or municipal law,
ordinance or regulation which is punishable by a fine and/or jail sentence, excluding minor traffic and parking violations?
Yes No If yes, describe in full.
    
3. Have you ever plead guilty, been found guilty of, or entered a plea of no contest to a violation of any federal, state or municipal law, ordinance or regulation which is punishable by a fine and/or jail sentence, excluding minor traffic and parking violations?
Yes No If yes, describe in full.
    
4. Have you ever been placed on probation or received a suspended imposition of sentence (SIS) relating to a violation of any federal, state or municipal law, ordinance or regulation which is punishable by a fine and/or jail sentence, excluding minor traffic and parking violations?
Yes No If yes, describe in full.
    

*EDUCATIONName,City & State of School(s)Dates Attended# Years CompletedDid you graduate?Degree/Diploma
College/VocationalYes
No
College/VocationalYes
No
High School Yes
No

COMPLETE THIS SECTION IF YOU SERVED IN THE U.S. ARMED FORCES:
Describe your duties and any special training:
 Branch of Service:

 Period of Duty:

 Date of Discharge:
EMPLOYMENT HISTORY (List most recent employer first)
Company Name (1)
Telephone: EX: 555-555-5555
Address:
Dates Employed:  EX: mm-dd-yyyy to mm-dd-yyyy
Supervisor:
Pay:
 Choose One:
PER: HourWeek MonthYear
Job Title and Duties
Reason for Leaving

Company Name (2)
Telephone: EX: 555-555-5555
Address:
Dates Employed:  EX: mm-dd-yyyy to mm-dd-yyyy
Supervisor:
Pay:
 Choose One:
PER: HourWeek MonthYear
Job Title and Duties
Reason for Leaving

Company Name (3)
Telephone: EX: 555-555-5555
Address:
Dates Employed:  EX: mm-dd-yyyy to mm-dd-yyyy
Supervisor:
Pay:
 Choose One:
PER: HourWeek MonthYear
Job Title and Duties
Reason for Leaving

*REFERENCES
Reference 1Position
TelephoneAddress
Reference 2Position
TelephoneAddress
Reference 3Position
TelephoneAddress
We may contact employers and references listed unless you indicate those not to contact by the numbers above.Reason:

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. I authorize the Kirkwood School District to obtain verification of the information listed above, and to maintain all submitted information in a confidential file available only to the Kirkwood School District.

I understand and consent to having criminal and arrest records checks as well as background checks by the Missouri Division of Family Services as a condition for consideration of my application for employment. 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. Satisfactory county/city record check, state record check, Division of Family Services child abuse and neglect screening, FBI fingerprint cards, and negative Tuberculosis PPD results must be filed with the Human Resources Department at the time of employment as a condition of employment.

I understand that this application will be considered active through December 31st. I understand that if I wish my candidacy to remain open after that date I must submit another application and all application materials.



Add your Resume, Letters of Reference and any additional information. You can copy and paste the information or use the text box below to construct the information. Scan your documents and copy & paste them into the space below.
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For all questions and concerns about this form contact the district web master.
To Mail Application:
Ms Jeanette Tendai
Kirkwood School District
Department of Human Resources
11289 Manchester Rd
Kirkwood, Mo. 63122
Include or Forward:
All Transcripts
Placement File/Recommendation Letters
Certification
Resume
NOTICE OF DISCRIMINATION: The Kirkwood R-7 School District does not discriminate on the basis of sex, race, religion, age, national origin, handicap, or disability in admissions or access to, or treatment or employment in its programs and activities. Any person having inquiries concerning the District's compliance with Title IX and Section 504 should contact Ms Jeanette Tendai, Assistant Superintendent for Human Resources and Administration, by calling (314) 213-6103.