Application for Rockland Central School District

Application for Rockland Central School District

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Welcome to our application. Please read all instructions carefully. Please allocate proper time to fill out the form in one setting, we recommend completing from a desktop/laptop and allocating about 30 minutes to complete the application in full.

The application will walk you through a series of pages:
- A helpful description will be provided on the top of each page.
- Your progress can be seen at the bottom of the page.
- Once you have filled out all required fields on a page (designated with a *), and all applicable non-required fields, you may press Next to proceed to the next page.
- If you ever want to revisit a question on a previous page, you can press Back to return to the last page.
- If a field is not-required and does not apply, please leave it blank. If a required field seems that it does not apply, please enter "N/A"
- When completed, the last page of the form will allow you to digitally sign and submit the application. You will also have the opportunity to attach any additional documents or add any additional comments or notes desired.
Personal Information

Please provide the following personal contact information.
Name*
Primary Email*
Secondary Email
Primary Phone*
Secondary Phone
Home Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Work Information

Please provide information on your current employer.
Current Employer
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Work Phone
Current Position
Years in Position
Enrollment
Number of Staff
Annual Budget ($k)

Graduate Information

Please provide up to 3 of your recent graduate education. The NEXT page will allow you to enter undergraduate education.
Attended the school of Graduate School Name* in City*   State* majoring in   Name of Major*   with a degree in   Name of Degree*   conferred on   Date*.

If applicable, also attended the school of Graduate School Name in City   State majoring in Name of Major with a degree in   Name of Degree   conferred on   Date.

If applicable, also attended the school of Graduate School Name   in City   State majoring in   Name of Major   with a degree in   Name of Degree   conferred on Date.

Undergraduate Education

Please provide up to 3 of your most recent undergraduate schools. Graduate schools should be entered on the previous page.
Attended the school of Undergraduate School Name*   in         City*   State*      majoring in    Name of Major*    with a degree in    Name of Degree*   conferred on   Date*   .

If applicable, also attended the school of   Undergraduate School Name   in         City   State      majoring in   Name of Major   with a degree in   Name of Degree      conferred on    Date   .

If applicable, also attended the school of   Undergraduate School Name   in         City   State      majoring in   Name of Major   with a degree in   Name of Degree   conferred on   Date   .

Certifications

Please provide up 3 certifications.
Certified in Certification Name in State with certification number   Number and an expiry date of Date.

If applicable, also certified in Certification Name   in State with certification number   Number and an expiry date of   Date.

If applicable, also certified in Certification Name   in State with certification number   Number and an expiry date of   Date.

Administrative Experience

Please include up to 5 previous administrative experience positions, ordered by most recent first. Please only include administrative experience, any teaching or other experience will be entered on the next pages.
Held the position of Position Title from Date to Date for Name of School District/Org at   Street Address      City   State   Zip.

If applicable, also held the position of   Position Title   from   Date   to   Date   for   Name of School District/Org   at   Street Address      City   State   Zip   .

If applicable, also held the position of   Position Title   from   Date   to   Date   for   Name of School District/Org   at   Street Address      City   State   Zip.

If applicable, also held the position of   Position Title   from   Date   to   Date   for   Name of School District/Org   at   Street Address      City   State   Zip.

If applicable, also held the position of   Position Title   from   Date   to   Date   for   Name of School District/Org   at   Street Address      City   State   Zip.

Classroom Teaching Experience

Please enter up to 2 classroom teaching experience positions, ordered by most recent first. The following page will allow you to list any applicable non-educational experience positions.
Held the position of Position Title teaching Subject for grade Grade Number from Date to Date for School/District Name at Street Address City State Zip.

If applicable, also held the position of Position Title teaching Subject for grade Grade Number from Date to Date for School/District Name at Street Address City State Zip.

Non-Educational Experience

Use this page to list up to 2 recent non-educational experience, ordered by most recent first.
Held the position of Type of Work for Firm at Street Address City State Zip from Date to Date with immediate supervisor First Name Last Name.

Held the position of Type of Work for Firm at Street Address City State Zip from Date to Date with immediate supervisor First Name Last Name.

Professional References

Do not include any subordinates. Please provide up to 6 professional references.

Reference 1
Name*
Primary Number*
Secondary Number
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/District/Organization*
Relationship to Candidate*
Years known to Candidate*

Reference 2
Name*
Primary Number*
Secondary Number
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/District/Organization*
Relationship to Candidate*
Years known to Candidate*

Reference 3
Name*
Primary Number*
Secondary Number*
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/District/Organization*
Relationship to Candidate*
Years known to Candidate*

Reference 4
Name
Primary Number
Secondary Number
Email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/District/Organization
Relationship to Candidate
Years known to Candidate

Reference 5
Name
Primary Number
Secondary Number
Email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/District/Organization
Relationship to Candidate
Years known to Candidate

Reference 6
Name
Primary Number
Secondary Number
Email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/District/Organization
Relationship to Candidate
Years known to Candidate

Application for Rockland Central School District

Personal Information

Work Information

Graduate Information

Undergraduate Education

Certifications

Administrative Experience

Classroom Teaching Experience

Non-Educational Experience

Professional References

Disclosure and Consent Form