Norris. Jacksonville, AR Jacksonville, AR Home. Federal Government. Department of Veteran Affairs

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1 Application ID: Y1V011VP5KR0QX1UVT1I Personal Information Title (Mr. Mrs., Ms., etc.) Middle Name: Mr. Norris Dean Cain Suffix (Sr. Jr. etc): Residential Address: County: 216 East Valentine PULASKI Preferred mailing address: Occupation: Home Federal Government Work/Business Name: Department of Veteran Affairs Business Address: 2200 Fort Roots Drive, Bldg. 65, North Little Rock, AR Home Phone: Office Phone: Mobile Phone: Fax: Address: Marital Status: If Married, spouse's name: Spouse's Occupation Spouse's Employer Married Shawnise Powell-Cain Records Officer Job Corps of America Page 1

2 Appointment Information in which you reside: Are you, or have you ever been, an employee of the school district? Do you, or an immediate family member residing in your household, benefit from a contract with the school district, including an employment contract? Are you a registered voter in the county of your current residence? Are you, or have you ever been, registered as a lobbyist in the State of Arkansas? PULASKI COUNTY SPECIAL SCHOOL DISTRICT No No Yes No If so, please list dates that your registration was/is active: Page 2

3 Educational Information High School: Oak Grove High Year Graduated: 1982 List post-secondary educational institutions attended. Educational Institution 1 School Name: City: State: North Central University Flag Staff NV Dates Attended: 09/2007 to 06/2014 Certificates/Degrees Received: Reached Candidate status for Ph.D in educational leadership (current) Educational Institution 2 School Name: City: State: Webster University St. Louise MO Dates Attended: 10/1995 to 10/1998 Certificates/Degrees Received: MBA in Business MA in Human Resource Development Educational Institution 3 School Name: City: State: University of Central Arkansas Conway AR Dates Attended: 08/1992 to 08/1995 Certificates/Degrees Received: Certification in Community Development Page 3

4 Work History Employment History: Military Officer - Retired from the Arkansas Air National Guard/Active Duty Air Force Adminstrative Officer with Remington Colleges Adjunct Professor with ITT Tech Colleges Present - Rating Veterans' Service Representative Page 4

5 Organization, Memberships, Community Services Previous service on school boards of directors (dates and terms of office): Kappi Delta Pi - Education Fraternity Committee Member of Job Corps of America Tostmasters International Bible Fellowship Christian (BSF) Member Future Leadership Enrichment and Development Program Disabled American Veterans American Legion Military Officer Retire Association Additional appointments, elected positions, or other offices with dates and terms: President of Toastmasters - Little Rock 1998 Military Officer 1984 to 2009 National Technical Honory Society Coordinator Community Liaison - Hurricane Katrina Qualifications that you feel make you a good canditate for this appointment: I have several years of community service - particulary issues relating to school development and student issues. I spent several years working with various school districts around the state - presenting information to the student and administrative body about the necessity to maintaing a healthy active school. I have a certification in community development which allows me to understand the perspective of those living in the community. I have contributed hundreds of volunteer hours to many community efforts in the state of Arkansas. I have completed all of necessary class work for my Ph.D in Educational Leadership other than the dissertation - considered a Ph.D candidate. This has allowed me to understand situations from an administrative perspective. Professional licenses/certificates held: Certification in Community Development Certification in Training and Development Training Page 5

6 Additional Information Mr. Tony Wood Are you willing to serve as a volunteer without compensation? Are you willing to make yourself available for training provided by the? How often are you willing to meet if required? Yes Yes As Required List three in-state references that have known you well within the past five (years). Reference 1: Jay Mergenscher Address: 4705 Meadowridge Lane Alexander, AR Phone: jay.mergenscher@va.gov Reference 2: Ronald McDaniiel Address: 7204 Northlake Drive Phone: ronald.mcdaniel1952@gmail.co m Reference 3: JoEllen Polite Address: 1109 Colonial Drive Phone: Iampolite@comcast.net Page 6

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