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

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

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)

Memberships and Affiliations Educational, Professional, and Other

Organization Leadership Role(s) Dates

Community Activities

Activity Location Dates

Military Experience

Branch Date of Entry Date of Separation

Additional Questions and Signatures

Are you presently being investigated or under a procedure to consider

discharge for misconduct by your present employer? Yes No

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

from a prior position? Yes No

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

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

of another person? Yes No

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

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.

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

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

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

Describe your management philosophy and style.