ADMINISTRATIVE POSITION APPLICATION
(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
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2
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4
5
Experience List in Order Beginning with your Present Position
District & School Dates Position Reason for Leaving
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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
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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)
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3
4
5
Memberships and Affiliations Educational, Professional, and Other
Organization Leadership Role(s) Dates
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5
Community Activities
Activity Location Dates
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5
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.