Application for the Position of Assistant Superintendent Ofschoolsking and Queen County

Application for the Position of Assistant Superintendent Ofschoolsking and Queen County

Application for the Position of Assistant Superintendent ofSchoolsKing and Queen County PublicSchools

1.Name

(Last)(First)(Middle)

2.HomeAddressBusinessAddress

(Street)(Street)

(City)(City)

(State)(Zip)(State)(Zip)TelephoneNumber TelephoneNumber

Social SecurityNumberEmail

3.Preferred Mailing Address:HomeBusiness

4.PresentPosition

5.School District orOrganization

6.If a school district, please provide the followinginformation

Size of district’s annualbudget No. of Non-certifiedStaff Current studentenrollment

No. ofteachers No. admin./supervisorypersonnel No. ofschools

7.If other than a school district, please provide the followinginformation

Size of budget for whichresponsibleNo.employees/organization

Number of persons reporting to youpersonally

8.EMPLOYMENT HISTORY (please list all full-time positions held within the fieldofeducation)

Organization andLocationPositionSalaryFrom/To No.of years Size ofUnit

Please attach an additional sheet to complete, ifnecessary.

Total No. ofYears

9.Have you ever been involved in or initiated a Court Suit especially if it relates toyouremployment oremployees?

Yes

No

10.PROFESSIONAL PREPARATION: (Please list both undergraduate andgraduatematriculation in chronologicalorder.)

InstitutionLocationMajor/MinorDegreeDate ofDegree

Please attach an additional sheet to complete, ifnecessary.

*AreyoueligibleforcertificationasasuperintendentintheCommonwealthofVirginia?YES [ ] NO [ ]

If you are in doubt about your status, contact Ms. Patty S. Pitts, Associate Specialist, Office ofProfessional Licensure,StateDepartmentofEducation,P.O.Box6-Q,Richmond,VA23216-2060;Telephoneat(804)225-2022.

11.PROFESSIONAL MEMBERSHIPS:(Pleaselistnamesoforganizationsandapproximate length ofmembership.)

Please attach an additional sheet to complete, ifnecessary.

12.COMMUNITY AND CIVICMEMBERSHIPS:

Please attach an additional sheet to complete, ifnecessary.

13.HONORS ANDAWARDS:

Please attach an additional sheet to complete, ifnecessary.

14.PERSONAL PUBLICATIONS: (Please attach a list of the most significant andrelevantbooks or articles you have written andpublished.)

15.AREAS OF HIGHEST DEMONSTRATED COMPETENCE: (Please rank in orderofcompetence based upon experience or specialization in undergraduate andgraduatepreparation.)

Adaptability

BusinessManagement

ComprehensivePlanning

Curriculum/Instruction

EmployeeRelations

GeneralAdministration

SpecialEducation

VocationalEducation

ManagementofGrowth

PersonnelManagement

PublicRelations

StaffDevelopment

Supt./BoardRelations

Other (Specifybelow)

Please attach an additional sheet if you wish toelaborate.

16.Using a separate sheet of paper, please discuss your foremost motivation inseekingthis position.

17.REFERENCES: (Please list the names of not less than four (4) persons who aremostfamiliar with your work andqualifications.)

NAME POSITION PRESENTADDRESS TELEPHONENUMBER

1.

2.

3.

4.

18.INFORMATION ABOUT THIS POSITION VACANCY WAS RECEIVED FROM:

(NAME)

(ADDRESS)

I have requested a copy of my credentials from the followinginstitutions:

1.

2.

3.

19.SIGNATURE:

DATE:

Finalists may be asked to submit a video tape/DVD of themselves presidingorpresentingduringaschoolboardmeeting,PTAmeetingorothermassmeetinginthecommunity. Finalists may also be asked to provide a copy of their most recentevaluationby their school board and/or immediatesupervisor.

Applications and supporting materials should be submitted on or before May 31, 2015. Applications will be accepted and reviewed until the position is filled.

Dr. Carol B. Carter

King Queen Elementary School

24667 The Trail

Mattaponi, VA23110

King and Queen County Public Schools is an Equal OpportunityEmployer

FOR OFFICE USEONLY

Date applicationreceived

Transcriptsreceived

Acknowledge

Credentialsreceived

ReferencerequestedReferencesreceived