Wellington‐Napoleon R‐IX School District P.O. Box 280, 800 N. Highway 131 Wellington, Missouri 64097 Phone: 816‐934‐2531 Fax: 816‐934‐8649 APPLICATION FOR TEACHING POSITION Name ____________________________ Last Name _____________________________ ____________________ First Name Middle Name Present Address________________________________________________________________________________ Permanent Address_____________________________________________________________________________ Social Security Number ________________ Home Phone__________________ Business Phone________________ Position Desired: Grade level/Subject______________________________________________________________ With what community organizations are you associated?_______________________________________________ _____________________________________________________________________________________________ List experiences with youth organizations such as Scouts, Campfire, etc.___________________________________ _____________________________________________________________________________________________ Please request that your credentials be sent from the Placement Office at your earliest convenience. EDUCATION AND PROFESSIONAL TRAINING High School_______________________ College Attended Name and Location Address__________________________ Year Completed______ Date of Attendance Degree
Area of Specialization Total Credit Hours CERTIFICATION INFORMATION Subject Grade Level Type of Certification
Effective Date Expiration Date
TEACHING EXPERIENCE Name and Location of School or Institution Grade or Subjects Dates of Service
Number of Years
Salary
Applicants are considered for all positions without regard to race, color, religion, sex, disability, national origin, age, marital or veteran status. If you have any questions, please contact Jeff Ruskey, P.O. Box 280, Wellington, Missouri, 64097, 816‐934‐2531 or Jeff.Ruskey@well‐nap.k12.mo.us Teaching Experience continued Total Years in Elementary School_________ Jr. High School__________ Senior High School__________ Please complete the following information in reference to your observation and student teaching experience. Grade Level________________________________ Subject Area___________________________________ Add by letter any additional information that will give a more complete estimate of your training, experience, character, and ability. GENERAL INFORMATION Have you ever been non‐renewed? Where? If yes, please explain with an attached statement. ____________________________________________________________________________________________ Why do you wish to leave your present position?____________________________________________________ Why do you wish to teach at Wellington‐Napoleon?__________________________________________________ ____________________________________________________________________________________________ What is your current salary?___________ What salary to you expect to receive here?____________ EXTRA‐CURRICULAR EXPERIENCE Name & Location of School Sport or Activity
Dates of Service
Number of Years in Sport/Activity
RECENT REFERENCES NAME ADDRESS
OFFICIAL POSITION
PHONE NUMBER
I certify that the information and statements provided in this application are true to the best of my knowledge and belief Applicant Name_____________________________________________ Date________________________ In submitting this application, I authorize Wellington‐Napoleon School District to contact all listed references, to make all contacts appropriate to my past vocational and educational history and to maintain all such information in a confidential file available in Wellington‐Napoleon School District as a prospective employer. I understand that any falsification or omission of information that might affect the objective evaluation of my application may result in immediate termination of my application/employment. I also authorize Wellington‐Napoleon School District to make all necessary and appropriate investigations allowable by law of my prior background. Applicant Name_________________________________________________ Date______________________________ Please email this application to: jeff.ruskey@well‐nap.k12.mo.us