Revised 4/16/10

DISTRICT USE ONLY:
Position recommended ______Building ______
Salary step/Experience______Beginning Date ______
Special Circumstances______

Muscatine Community Schools

2900 Mulberry Avenue

Muscatine IA 52761

563-263-7223 or 563-263-7729 (Fax)

The mission of the Muscatine Community School District is to ensure excellence in education for every student.

Principal/School Administrator

An application for a position is not considered complete until this form, your transcripts and references are given. All questions must be answered. You may attach additional information as needed. No interviews are granted unless applications are complete.

Name:

Present Address:

Street City State Zip Code

Home Phone:Other Phone

Present Address:

Street City State Zip Code

Position Desired: (Indicate grades or subjects and level)

College (University) Granting Teacher CertificationYear of Graduation/Certification

CERTIFICATION

Do you hold a current Iowa certificate? Certification in other states?

List all endorsements, grade level and approvals:

If you do not hold an Iowa certificate, please write to the Department of Education, Grimes State Office Building, Des Moines, Iowa, 50319, or call 515-281-3245 regarding your eligibility for an Iowa certificate. The district does not assume any responsibility for your certification. All contracts require a valid Iowa teaching certificate before any salary is paid.

EDUCATION

An official transcript of your college credits is desirable, but not required. For application purposes only, it may be a copy of an official transcript.

College/University Attended / Dates / Degree/Date / Major / Minor

PROFESSIONAL EXPERIENCE

Name of School/District / Position / Years / Responsibilities

PROFESSIONAL MEMBERSHIPS and RECENTCOMMUNITYACTIVITIES

REFERENCES

Name/Title / Address / Telephone / Relationship/Knowledge
Of Your Work

The following questions are designed to assist us in the selection process. Your concise and candid responses are important. Please limit your answers to the space provided.

Describe your administrative style. Please use specific examples from your past experience that illustrate your administrative style:

What do you consider to be your major strengths as an administrator/future administrator? Denote any significant contributions you have made to your present school district which illustrates those strengths:

Please provide specific examples of how you have promoted and implemented educational programs by working with teachers, staff, and the community:

PROFESSIONAL DATA

What are your reasons for wishing to change from your position?

What special reasons do you have for wishing to be an administrator forthe Muscatine School District?

If not employed at present, why did you leave your last position?

Have you ever been dismissed, asked to resign or failed re-election?

Where? State reasons

You are not required to disclose information about physical or mental limitations that you believe will not interfere with your ability to do the job. On the other hand, if you want the employer to consider special arrangements to accommodate a physical or mental impairment, you may identify that impairment and suggest the kind of accommodation which you believe would be appropriate.

I certify by my signature that the above answers and information are true as of this date and also signify that I will update the information and answers as circumstances change hereafter until my application is finally acted upon. I understand that inaccuracies, or dishonest, or misleading answers will cause rejection of my application or discharge once employed.

Signature Date

It is the policy of the Muscatine Community School District not to discriminate on the bases of race, creed, color, gender, marital status, parental status, sexual orientation, gender identity, national origin, religion, age, veteran status or disability in its educational programs, activities, or employment practices. If you believe you have been discriminated against or treated unjustly, please contact Equity Director(s) Perry Rodocker, 621 Kindler Ave, 263-9049, or Wes Fowler, 2900 Mulberry Ave, 263-7223, Civil Rights Compliance Officer Roberta Swanson, 2705 Cedar Street, 263-6141, Affirmative Action Coordinate Wes Fowler, 2900 Mulberry Ave, 263-7223, or the 504 Coordinator Jan Collinson, 2900 Mulberry Ave, 263-7223. They will discuss the situation with you and if you wish help you file a grievance.