CHURCHILL COUNTY SCHOOL DISTRICT

CHURCHILL COUNTY SCHOOL DISTRICT

FALLON, NEVADA
SUPERINTENDENT APPLICATION
APPLICATION INSTRUCTIONS
Thank you for your interest in the position of Superintendent of Schools for Churchill County School District. Please complete this application in full and submit all required materials by the deadline indicated in the official vacancy announcement. Incomplete applications may not be considered.

Applicants are encouraged to review the Superintendent Candidate Profile before submitting materials.
APPLICANT INFORMATION (Please type or print)
Full Legal Name

First NameMiddle InitialLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone
Cell Phone
Email Address
example@example.com
Are you authorized to work in the United States?

YesNo
PROFESSIONAL CREDENTIALS
State of License
License #
Expiration Date
Do you hold, or are you eligible to obtain, a valid Nevada Administrator's license?

YesNo
Other relevant administrative licenses or certifications

PROFESSIONAL EXPERIENCE SUMMARY
Please provide a brief overview of your experience as it relates to the superintendent role, including district size, scope of responsibility, and key leadership accomplishments.

EMPLOYMENT INFORMATION
Current Employer
Employer Name
Years with Current Employer
Current Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Responsibility
How many people do you supervise in your current role?
What is the total amount of the budget you administered?
Supervisor with Current Employer
Supervisor Name
Supervisor Title
Supervisor Cell Phone #
Supervisor Email Address
example@example.com
Present Contractual Situation
What is the length, in years, of your current contract?
When does your current contract expire?

MonthDayYear
Date
Approximately, what is your total annual compensation?
What total annual compensation are you expecting (explain)?
Previous Employer (if applicable)
Previous Employer Name
Years with Previous Employer

EDUCATION
Highest Degree Earned
College or University
Field of Study
Additional Degrees of Relevant Training

REQUIRED AUTHORIZATIONS AND ACKNOWLEDGEMENTS
Authorization for Background Investigation and Release - I authorize Churchill County School District and its representatives to investigate all statements contained in this application and any accompanying materials as may be necessary in arriving at an employment decision. Such investigation may include contacting law enforcement agencies, current and former employers, professional references, and other persons or entities with relevant information regarding my background, qualifications, or employment history.

I hereby release and agree to hold harmless Churchill County School District and any person or entity that, in good faith, provides information pursuant to this authorization from any and all liability arising from such disclosure.
Yes
If you answered "Yes" above, type your initials in the box below to verify your consent for authorization and release.
Open Records Acknowledgment - I understand that application materials may be subject to disclosure under Nevada public records laws.
Yes
If you answered "Yes" above, type your initials in the box below to verify your understanding of the Open Records Acknowledgement.
Residency Requirement Acknowledgement-I acknowledge that, if offered the position of Superintendent, Churchill County School District policy requires the Superintendent to establish residency within Churchill County within six (6) months of employment. I understand and agree to comply with this requirement.
Yes
If you answered "Yes" above, type your initials in the box below to verify your understanding of the Residency Requirement.

Letter of Interest

Please upload a Letter of Interest addressing the candidate’s qualifications, leadership experience, and interest in serving as Superintendent of Churchill County School District.
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Resume

Please upload your Resume, which should include your complete education background, your employment history, and a list of 5 professional references, with at least two being from current or former supervisors.
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Waiver of Potential Statutory Notice

Please upload the signed and dated Waiver of Potential Statutory Notice.
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Background Check Disclosure and Authorization

Please upload the signed and dated Background Check Disclosure and Authorization form.
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Statement of Explanation - Background & Eligibility Questions (if applicable)

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APPLICATION CERTIFICATION AND SIGNATURE
I certify that the information provided in this application and in any accompanying materials is true, complete, and accurate to the best of my knowledge. I understand that any false, misleading, or omitted information may result in disqualification from consideration or termination of employment if discovered at a later date.
Signature of Applicant:

Clear
Date:

MonthDayYear
Date
Incomplete applications may not be considered.
Should be Empty:

CHURCHILL COUNTY SCHOOL DISTRICT

SUPERINTENDENT APPLICATION

APPLICATION INSTRUCTIONS

APPLICANT INFORMATION (Please type or print)

PROFESSIONAL CREDENTIALS

PROFESSIONAL EXPERIENCE SUMMARY

EMPLOYMENT INFORMATION

Current Employer

Responsibility

Supervisor with Current Employer

Present Contractual Situation

Previous Employer (if applicable)

EDUCATION

PROFESSIONAL DISCLOSURES

Reference Permission - Please indicate your reference check preference

BACKGROUND & ELIGIBILITY QUESTIONS

REQUIRED AUTHORIZATIONS AND ACKNOWLEDGEMENTS

APPLICATION CERTIFICATION AND SIGNATURE