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