School Administration Application

NORTH LAWRENCE COMMUNITY SCHOOLS Administrative Service Center 460 W Street, P.O. Box 729 Bedford, IN 47421 Telephone (812) 279-3521
Action By Employing Officials	Initial and Date After Reviewing
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School Administration
Application
Please fill out blanks with complete, detailed information.
You are encouraged to attach a vita sheet.

Name:

Date of Application: 2/21/2019

First

Middle

Maiden

Last

Present Address:

Home Phone Number:

City/State/Zip:

Office Phone Number:

Email Address:

Present Position:

Note: Before Employment, A Personal Interview is Necessary

Have you previously applied for a position in this school system? Yes No Date

Please list the types of positions you desire, in order of preference:

(1)

(2)

(3)

Organizational Affiliation

Organization	Position	Remarks

License Information

Type of License (Elem., Sec., etc)	Provisional Or Professional	Date of Issue	Date Expires	Serial Number	Subject Area

Mentorship Required: Yes No

Education and Professional Training

Type of School	Name & Location of Schools	Courses Majored In	Degree or Diploma
High School			Diploma Yes No
College			List Degree	Sem. Hrs.
College			List Degree	Sem. Hrs.
Graduate School			List Degree	Sem. Hrs.
Other:

Scholastic Standing in High School In College

Work Experience Other Than Teaching In Last Five Years

Name and Location Of Company (Begin with most recent)	Kind Of Business	From ex) 01/2001	To 02/2004	Reasons For Leaving





Professional Experience
Name and Location Of School (Begin with most recent)	Position	From ex) 01/2001	To 02/2004	Reasons For Leaving

References

Give references including Supervising Teachers, Principals, and Superintendents under which you have taught or student taught.

	Name	Address	Official Position
1.
2.
3.
4.
5.

Name under which transcripts and employment records may be indentified if different from your present name:

College Placement File Number; if known	No.	College:
	No.	College:

Transcript: Sent For	Received	Credentials: Sent For	Received
Notification Promised By		Letter	Phone

Important Salary Information

The basis upon which salary would be computed
	Number of years of military service	Check All Degrees Received:
	Number of years teaching	BS
	Number of years Administration	BA
		MS
	Total:	MA
		Ed. Spec.
		Ed. D.
	Semester hours above masters' degree	Ph. D.

Who referred you to this school district?

Date available to begin employment:

In a short statement below, tell us why you have applied for a position in the North Lawrence Community Schools

I hereby certify that to the best of my knowledge the foregoing statements are true and complete. I further understand that this application will become a part of my permanent personnel file should I become employed by the North Lawrence Community Schools. I also signify by submitting this application electronically that permission is given for this prospective employer to receive and view any copies of my school or college record, or any references that I or the school system may select without my inspection of the information.

__________________________________________________	__________________________________________________
Signature	Date

Note: This application will be kept active for two (2) years unless employed during that time.

If you are hired for a position with North Lawrence Community Schools, administrative personnel must process a criminal history check. The applicant will be required to cover the cost for the criminal history check. If you are hired for a position with North Lawrence Community Schools, administrative personnel must process a criminal history check/child abuse registry check. You will receive an invitation by email from the personnel department to process this information through Safe hiring solutions and payment will need to be made by credit/debit card.

An authorization form must be completed before the Criminal History check is done.

The North Lawrence Community School Corporation does not discriminate against any individual because of race, sex, color, religion, creed, age, national origin, or physical handicap in the operation of its educational programs or activities.