South Henry School Corporation

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  • (Printable Administrative Position Application)

     

    Administrative Application

    SOUTH HENRY SCHOOL CORPORATION

    6972 S. State Rd. 103

    Straughn, IN  47387

     

    Please complete the following application and submit as part of the application package.

    Please type or print clearly.

    Personal Data

     

    Name: _____________________________________________________________________

                            Last                                             First                                                                        Middle

     

    Home Address: ______________________________________________________________

                            Number and Street                             City                                State                               Zip

     

    Home Telephone Number: _____________________________________________________

                                                                Area Code                     Number

    Business Address: ____________________________________________________________

                               Number and Street                          City                                State                               Zip

     

    Business Telephone Number: ___________________________________________________

                                                                Area Code                     Number

    Present Position: _____________________________________________________________

     

    Name of the School District: ____________________________________________________

     

                 # Pupils Enrolled             ______                 # Elementary Schools       ______

                 # Certified Staff               ______                 # Middle/Jr. High Schools              ______

                 # Non-Certified Staff        ______                 # Senior High Schools      ______

     

    Brief Description of Current Responsibilities: ______________________________________

    ___________________________________________________________________________

    ___________________________________________________________________________

     

    Do You Hold a Valid Indiana Administrative License?     ______YES       ______NO

     

    What license and/or certification do you hold that would make you a viable candidate for an Administrative Position with South Henry School Corporation?

    _________________________________________________________________________________________________________________________

    ______________________________________________________________________________

     

    Length of Present Contract: _____________________        Expiration Date: ____________

     

    Present Salary: _______________________________        Date Available: _____________

     

    Should this application be treated as confidential with regard to your present employer?  Yes  No
    Education

    High School                                     Location                                                          Year Graduated

     

     

    College or University                      Location           Major           Minor           Degree           Date

    1

    2

    3

    4

    5

     

     

    Experience     List in Order Beginning with your Present Position

    District & School                             Dates                Position                             Reason for Leaving

    1

    2

    3

    4

    5

     

     

    References     List the names of three people, other than those from whom you are submitting letters of recommendation, who know you and your work.

    Name                                    Position                          Address                           Telephone Number

    1

    2

    3

     

     

    Honors and Distinctions     List Honors, Awards, Commendations, Elective or Appointive Offices Held, or Other Distinctions Received

    Date                       Honor (include the institution or source)                          Comment (if desired)

    1

    2

    3

    4

    5

     

     

    Memberships and Affiliations     Educational, Professional, and Other

    Organization                                                     Leadership Role(s)                                          Dates

    1

    2

    3

    4

    5

     

     

    Community Activities    

    Activity                                                                             Location                                          Dates

    1

    2

    3

    4

    5

     


    Military Experience

    Branch                                                      Date of Entry                                      Date of Separation

     

     

     

    Additional Questions and Signatures

     

    1. Are you presently being investigated or under a procedure to consider

    discharge for misconduct by your present employer?                                        Yes      No

     

    1. Have you been reprimanded, disciplined, discharged, or asked to resign

    from a prior position?                                                                                    Yes      No

     

    1. Have you resigned from a prior position without being asked, but under

    circumstances involving your employer’s investigation of sexual conduct

    with another person, mishandling of funds, or criminal conduct?                          Yes      No

     

    1. Have you been charged with or investigated for physical or sexual abuse

    of another person?                                                                                           Yes      No

     

    1. Have you ever been charged with, pleaded guilty or “no contest” to, or

    been convicted of any crime involving sexual abuse of any person or any

    other crime of moral turpitude that has not been expunged?                                  Yes      No

       

    1. Have you ever been convicted of a misdemeanor and/or felony, or a

    plea “no contest,” or has any court ever deferred further proceedings

    without entering a finding of guilty, or placed you on probation for any

    crime that has not been expunged?                                                                     Yes      No

         

    If you have answered yes to any one of the previous six questions, please attach a written explanation, including the date of the incident, charge, any court action taken, the offense in question, and the address of any court involved.

     

    I understand that any false or misleading information on this application shall be fully sufficient grounds to refuse employment and/or terminate any employment contract.

     

    Signature: _________________________________________Date:___________________

     

    I authorize investigation of all statements in this application, including investigation of previous employment experiences if I am considered for employment.  I certify that the above answers are true and complete and understand that falsification on this application shall be considered sufficient cause for disqualification or dismissal.  References and personal information, which become part of this record, are to be regarded as confidential and will not be revealed.

     

    Signature: ________________________________________ Date: ____________________

     

                       

    South Henry School Corporation                                                                                 An Equal Opportunity Employer

                                                                                                                                                                                 Page 4

     

    Personal Response Questions     Attach additional sheets if necessary.  Responses should total no more than four pages.

     

    1. List and describe the talents and skills that you possess that would make you a successful candidate?

     

     

     

     

     

     

     

     

     

     

    1. What is the most important function in a school system to maximize student achievement and how would you provide for it?

     

     

     

     

     

     

     

     

     

     

     

    1. In what area(s) do you feel least qualified for this position?

     

     

     

     

     

               

     

     

     

     

    1. Describe your management philosophy and style.

     

     

     

     

     

     

     

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