Box 291, Scandia, Kansas Phone (785) Fax (785) Name (Last) (First) (Middle Initial) Present Address: Telephone

Transcription

1 Pike Valley Unified School District No. 426 Box 291, Scandia, Kansas Phone (785) Fax (785) Application for High School Principal Name (Last) (First) (Middle Initial) Present Address: Street City State Zip Telephone Permanent Address: (if different than above) Street City State Zip Telephone Social Security Number Address Applications To: Pike Valley U.S.D. #426 Vicki Nylund, Clerk of the Board P.O. Box 291 Scandia, KS Attn: High School Principal Application Date of Candidate s availability : Date of Application: Opening Doors to Success

2 General Information Yes No Are you Currently under Contract? If so when does your contractual obligation expire? Yes No Are you now certified to be a High School Principal in Kansas? Yes No Have you ever been refused a continuing contract? (If yes, explain below.) Yes No Have you ever been discharged or requested to resign from a position? (If yes, explain below.) Yes No Have you ever been placed on probation? (If yes, explain below.) Comments: Security Yes No Have you ever been convicted of a felony and/or served time for a felony in the past seven years? (If yes, explain below.) Yes No Have you ever been convicted of any crimes of moral turpitude or offenses involving children, disabled, or the elderly? Comments:

3 Educational/Professional Training Educational Data School Attended and Location High School Inclusive Dates Degree/Hours Major Field Workshops or Seminars Number of semester hours in major field: Undergraduate Graduate Number of semester hours in minor field Undergraduate Graduate College Honors and Activities College Placement Bureau where your credentials are available.

4 Chronological Education Employment Date School District and Location/District Enrollment Position/Duties Annual Salary Reason for Leaving References List three character references who are not related to you and have known you for at least three years. Name Address/Telephone Business Is it permissible to contact any or all of the references? If no, after what date would it be permissible? If you are a finalist for the position, is it permissible for the board to visit your current district?

5 Other Training or Experience Related to the Position Applying For Description of Job Name/Address of Company Telephone Number Dates Worked Name of Supervisor If selected and conditions prove satisfactory to you, do you have any plans which would prevent your administrative work in our school district for at least two years? State briefly your reasons for wishing to be a Principal in our district. Please mention here anything not included elsewhere in this application which you feel will further support your candidacy.

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7 Candidate's Educational Statements Please provide a brief narrative statement concerning your knowledge of management skill sin each of the following areas: Use the back if needed. Management skills in working with people. Knowledge of effective schools research Knowledge of outcomes - based education Knowledge of evaluation of programs and people Understanding of classroom use and modern technology

8 Professional Memberships relevant to position applied for. What level of knowledge do you have in the area of the College and Career Readiness Standards? I hereby certify that all information is true, accurate, and complete to the best of my knowledge. Any misrepresentation or willful omission of facts shall be sufficient cause for disqualification of this application or termination of employment. I hereby authorize Pike Valley U.S.D. #426 to conduct work history, personal references, and/or police record inquires to determine my acceptability for employment. Signature Date Pike Valley U.S.D. #426 does not discriminate on the basis of race, religion, color, national origin, sex, age or handicap in admission or access to, or treatment or employment in its programs and activities.