PERSONAL INFORMATIONmoadminjobs.com/sites/default/files/Superintendent Application_0.pdfFrancis Howell School District is an Equal Opportunity Employer. Francis Howell School District

Email application and supplemental materials to: [email protected]

Please complete all boxes

PERSONAL INFORMATION

First Name

Middle Name

Last Name

Other Names - Under which transcripts, certificates, and/or former applications may be listed

E-mail Address:

Number and Street:

Apt. Number:

City:

State:

Zip Code:

Daytime Phone Number:

Cell Phone Number

WORK EXPERIENCE

1) Current or Most Recent Position

Employer Name:

Position Title:

Employer Contact Information

Street:

City:

State:

Zip Code:

Supervisor Contact Information

Name:

Phone:

E-mail Address:

*Note for confidentiality reasons, all references will be checked with consent from candidate in final phase of process*

Employment Details

Date From:

Date To:

Status: Full Time Part Time Sub

Last Annual Salary:

Reason for Leaving:

Role/Responsibilities:

2) Previous Position Held

Employer Name:

Position Title:


Street:

City:

State:

Zipcode:


Name:

Phone:

E-mail Address:

Employment Details

Date From:

Date To:


Last Annual Salary:

Reason for Leaving:

Roles/Responsibilities/Accomplishments:


Employer Name:

Position Title:


Street:

City:

State:

Zipcode:


Name:

Phone:

E-mail Address:

Employment Details

Date From:

Date To:


Last Annual Salary:

Reason for Leaving:



Employer Name:

Position Title:


Street:

City:

State:

Zipcode:


Name:

Phone:

E-mail Address:

Employment Details

Date From:

Date To:


Last Annual Salary:

Reasons For Leaving:


EDUCATION

High School Details

Name:

City:

State:

Graduation Date:

Colleges, Universities, and Technical Schools Attended

Name

City and State

From:

To:

Major Area of Study:

Degree:

Date Conferred or Expected

Name:

City and State:

From:

To:


Degree:

Date Conferred or Expected:

Name:

City and State:

From:

To:


Degree:


Name:

City and State:

From:

To:


Degree:


Overall GPA

Undergraduate:

Graduate:

Graduate Program Area of Study:

List Honors, Awards, and/or Distinctions you have Earned:

CERTIFICATIONS

Do you hold a current Missouri Superintendent Certificate?

Yes No

LANGUAGE SKILLS

Do you know any language other than English?

Yes No

If yes, please indicate which language(s)

REFERENCES*Note for confidentiality reasons, all references will be checked with consent from candidate in final phase of process*

Reference 1

Name:

School/Organization:

Position Title:

Years Known:

Cell Phone:

Work Phone:

E-mail Address:

Reference 2

Name:


Position Title:

Years Known:

Cell Phone:

Work Phone:

E-mail Address:

Reference 3

Name:


Position Title:

Years Known:

Cell Phone:

Work Phone:

E-mail Address:

SUPPLEMENTAL MATERIALS

*Please attach the following documents with your submission email to [email protected]

Letter or Interest

Current Resume

Certified Copy of Teacher/Administrator Certificate

Transcripts

Entry Plan Outline

ADDITIONAL INFORMATION

What makes you a good candidate for Superintendent of Francis Howell?

DISCLOSURES

Contract Status

Are you currently under contract?

Yes No

If yes, which district?

If yes, when does it expire?

Professional Status

Have you obtained tenure status in any other district?

Yes No

If yes, where and when?

Have you ever been denied tenure?

Yes No

If yes, explain:

Have you ever had a teaching license or certificate revoked or suspended?

Yes No

If yes, explain:

Have you ever failed to be rehired, been asked to resign a position, resigned to avoid termination, or been terminated from employment?

Yes No

If yes, explain:

Are you a relative of any board member, administrator, or supervisor who is currently serving the School District?

Yes No

If yes, fill in below information

Name:

Position:

Relationship:

Can you perform all the essential job functions of the position for which you are applying with or without reasonable accommodation?

Yes No

List any accommodations:

Have you been employed with Francis Howell School District previously?

Yes No

If yes, where and when:

LEGAL INFORMATION

*Applicants should disclose ALL arrests, charges, and/or convictions.

Are you eligible to work in the U.S.

Yes No

Have you ever been convicted of a felony, misdemeanor, or ordinance violation?

Yes No

If yes, explain in detail, giving dates, municipalities, and county in which the incidence(s) occurred:

Have you ever received a suspended sentence?

Yes No

If yes, explain:

Have you ever pled guilty, nolo contendere, or entered an Alford plea?

Yes No

Have you ever been named as a defendant in a civil lawsuit relating to employment?

Yes No

If yes, explain:

Are you currently on probation or parole?

Yes No

If yes, explain:

Have you ever had a record expunged?

Yes No

If yes, explain:

Has a Family Services agency ever issued a finding regarding your involvement in the suspect of abuse or neglect of a child?

Yes No

If yes, explain:

Equal Opportunity Employer

Francis Howell School District is an Equal Opportunity Employer. Francis Howell School District ensures equal employment opportunities regardless of race, creed, gender, color, national origin, religion, age, sexual orientation, or disability. Any individual needing assistance in making application for any opening should contact the Department of Human Resources.

Applicant's Acknowledgement and Agreement

By checking the box below, candidate authorizes the school district to conduct an investigation of candidate pursuant to Missouri Statutes to determine whether candidate has been convicted of any criminal or drug offenses as set forth in such statutes. Candidate upon request, agrees to execute an investigation authorization form as a condition of employment. Missouri Statutes also stipulate that the School District do a check on the Statewide Sex Offender Database. Candidate may not be employed until such investigations have been initiated. I certify that the information given by me in this application is true in all respects and agree that if the information given is found to be false in any way, it shall be concluded sufficient cause for denial of employment or discharge. I authorize the use of any information in the application to verify my statements, a I authorize past employment verification.

Check Here:

EEO Voluntary Data Sheet

Government agencies require us to collect information and file periodic reports reflecting the gender, race, and/or ethnicity of applicants. The data collected enables us to analyze our hiring processes, and to ensure equal employment opportunity. The information requested below is voluntary and will not be available to individuals involved in the process. This information is kept separate from your application so that it remains confidential.

Gender Male FemaleX Choose not to Respond

Ethnic Group: Hispanic or Latino Not Hispanic or LatinoChoose not to Respond

Racial Group: White/CaucasianBlack/African AmericanAsianHispanic/LatinoAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderChoose not to Respond

THE INFORMATION PROVIDED ON THIS FORM WILL BE KEPT SEPARATE FROM YOUR APPLICATION FILE AND WILL NOT BE USED FOR ANY DECISIONS REGARDING THE TERMS AND/OR CONDITIONS OF YOUR EMPLOYMENT. THANK YOU.

Documents

PERSONAL INFORMATIONmoadminjobs.com/sites/default/files/Superintendent Application_0.pdfFrancis Howell School District is an Equal Opportunity Employer. Francis Howell School District