Admin Application

Application for Administrative Position
NAME
BIRTHDATE

MonthDayYear
Date
HOME ADDRESS
HOME PHONE
BUSINESS PHONE
CELL PHONE
E-MAIL ADDRESS
example@example.com
For what position are you applying?
DATE OF APPLICATION

MonthDayYear
Date
PROFESSIONAL DATA
1. Current Employment
Are you now under contract?
If so, when does your contractual obligation expire?
3. Are you now certified to be a Principal in Kansas?

CHRONOLOGICAL EDUCATION EMPLOYMENT

	School Name & Location	District Enrollment	Position Or Duties	Dates	Salary
1.
2.
3.
4.
5.

Professional memberships relevant to position applied for:
Character/Professional References

List names, addresses and phone numbers of two character or professional references:
1. Name
Address
Phone Number
2. Name
Address
Phone Number
List three persons who may be contacted to give current information on your qualifications for the principal’s position.
1. Position
Address/Phone Number
2. Position
Address/Phone Number
3. Position
Address/Phone Number
Is it permissible to contact any or all of the above references?
If no, after what date will contacts be permissible?
If you are selected for the position, is it permissible for the board to visit your current district?
PERSONAL DATA
1. Have you ever been convicted of a crime involving moral turpitude?
EDUCATIONAL DATA
1. High School
2. High school and date of graduation

MonthDayYear
Date

3. College training in chronological order:

	School Name & Location	Dates	Degrees/ Hours	Major/Field	Minor	Workshops or Seminars
1.
2.
3.
4.
5.
6.
7.

4.Number of semester hours in major field: blanks Graduate: blank
5. Number of semester hours in minor field: blanks Graduate: blank
6. College honors and activities:
OTHER WORK EXPERIENCE

3. College training in chronological order:

	Employer & Location	Duties	Months	Dates	Salary
1.
2.
3.

CANDIDATES EDUCATIONAL STATEMENTS
Please provide a brief narrative statement concerning your knowledge of or management skills in each of the following areas: (Attach separate sheet)
- Management skill in school curriculum and planning
- Management skills in working with school staff
- Knowledge of outcomes-based education
- Knowledge of evaluation of programs and people
ADDITIONAL DATA
1. If selected for this position, how will you hold students, teachers, and parents accountable for appropriate student behavior?
2. State briefly your reasons for wishing to be a Principal in USD #430 South Brown County.
3. Please mention here anything not included elsewhere in this application which you feel will further support your candidacy.
APPLICANT JOB APPLICATION ACKNOWLEDGEMENTS
I certify that all the information provided by me in this application is true and complete. I understand that any misstatement, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination.

I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damages that may result from furnishing such information to you. I authorize any background checks by any third party.

I authorize you to request, receive, and verify all information given on this application and I release you from all damages that may result from your doing so.

I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete such investigation, and I release you from all liability for any damages that may result from your doing so.
Signature of Applicant

Clear
Date

MonthDayYear
Date
Applicants for admission and employment, students, parents of elementary school students, employees, source of referral of application for admission and employment, and all unions or professional organizations holding collective bargaining on the basis of race, color, national origin, sex, age or handicap in admission or access to, or treatment or employment in its programs and activities. Any person having inquiries concerning Unified School District #430 compliance with the regulations implementing Title VI, Title IX, or Section 504 is directed to contact the Superintendent, 522 Central Avenue, Horton, Kansas 66439, 785-486-2611. The Superintendent has been designated by Unified School District #430 to coordinate the institution’s efforts to comply with the regulations implementing Title VI, Title IX and Section 504. Any person may also contact the Assistant Secretary of Civil Right, U.S. Department of Education, regarding the institution’s compliance with the regulations implementing Title VI, Title IX, or Section 504.
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Application for Administrative Position

PROFESSIONAL DATA

PERSONAL DATA

EDUCATIONAL DATA

OTHER WORK EXPERIENCE

CANDIDATES EDUCATIONAL STATEMENTS

ADDITIONAL DATA

APPLICANT JOB APPLICATION ACKNOWLEDGEMENTS