Support Staff Personnel by vp8ko7wG

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									                          SUPPORT STAFF PERSONNEL
                             APPLICATION FORM
                     MACON COUNTY R-I SCHOOL DISTRICT
                   702 N MISSOURI STREET, MACON MO 63552

                                                    DATE: _________________________


NAME ______________________________________________________________________________


ADDRESS ___________________________________________________________________________


SOCIAL SECURITY NUMBER ________________________________________________________


TELEPHONE: HOME __________________________WORK ______________________________


EMERGENCY CONTACT NAME & NUMBER __________________________________________


_____________________________________________________________________________________


POSITION(S) APPLIED FOR __________________________________________________________


EDUCATION: LAST GRADE COMPLETED__________________YEAR ____________________


SCHOOL NAME _____________________________________________________________________


TYPE OF DEGREE/DIPLOMA ________________________________________________________


IF COLLEGE DEGREE WAS NOT RECEIVED, THEN LIST AMOUNT OF HOURS EARNED
& THE AREA OF CONCENTRATION __________________________________________________


DRIVER AND/OR CHAUFFER LICENSE NO. _____________________EXP. DATE ___________


HAS YOUR LICENSE EVER BEEN SUSPENDED OR REVOKED? _________________________
IF SO, WHY? ________________________________________________________________________


HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES _________ NO _______________
REFERENCES:
NAME ________________________________________________PHONE # _____________________
ADDRESS ___________________________________________________________________________
POSITION __________________________________________________________________________
NAME ________________________________________________PHONE # _____________________
ADDRESS ___________________________________________________________________________
POSITION __________________________________________________________________________
NAME ________________________________________________PHONE # _____________________
ADDRESS ___________________________________________________________________________
POSITION __________________________________________________________________________




EXPERIENCE:
FROM/TO                                POSITION                        LOCATION
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


ARE YOU CURRENTLY WORKING FOR A NEIGHBORING SCHOOL DISTRICT AND ARE
A MEMBER OF THE NON-TEACHER OR TEACHER RETIREMENT SYSTEM? EXPLAIN:
_____________________________________________________________________________________
_____________________________________________________________________________________
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


The Macon R-I District does not discriminate in the areas of age, race, creed, color, religion, sex,
and national origin, veterans and the handicapped in regard to employment practices, recruitment,
admission, placement and retention of students. The position of the Title IX and Section 504
Coordinator is Superintendent Debbie Livingston. The Superintendent’s business address is 702 N
Missouri, Macon MO 63552, and her telephone number is 660-385-5719. Fax number is 660-385-
7179.

								
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