Maine School Administrative District No. 64

408 Main Street, PO Box 279

Corinth, Maine 04427

APPLICATION FOR PRINCIPAL POSITION

Central Middle School

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M.S.A.D. No. 64 does not discriminate in the operation of its educational and employment policies and will honor all appropriate laws relative to discrimination.

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Date ______________________________ Position Applying for:

Name _____________________________ ___________________________________

When will you be available? ___________ ___________________________________

Permanent Address _________________________________ Phone: _______________________

Temporary Address _________________________________ Phone: _______________________

Work Phone ___________________ I may be contacted at home ________ at work ___________

Are you presently under contract to a school system? _______ Yes _______ No

If yes: Name of System ________________________________________ State ________________

Position _____________________________ Contract expiration date __________________

EDUCATION: Transcripts, including grades, from all colleges/universities attended must be provided. It is essential that this section be completed accurately.

College/ University

Degree Awarded

Date Received

Major

No. Years Attended

Grade Point Average

EXPERIENCE: A resume must be provided. In addition to educational background and work experience, include extra-curricular activities in which you have been involved. Please list below positions held, employer and dates of employment for the past ten years. Please account for any gaps in employment on a separate page.

From (month/year)

To (month/year)

Position

Employer

Numbers of years of teaching experience __________

Number of years of administrative experience ________

Other relevant work experience, special recognitions awarded, and achievements:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Membership in professional organizations:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

CERTIFICATION: List certification(s) you hold and provide copy of certificates:

Class

Type

Level

Endorsement

Validation Date

Expiration Date

If you do not hold a Maine administrator’s certificate, for what type of Maine certificate are you applying and eligible to receive? _________________________________________________________________

____________________________________________________________________________________

NOTE: Candidates who do not hold Maine certification should direct an inquiry to the Maine Department of Education, Certification Office, Augusta, Maine 04333

BACKGROUND:

Have you ever been disciplined, discharged, or asked to resign from a prior position? Yes ___ No ___

Have you ever resigned from a prior position after a complaint had been received

against you or your conduct was under investigation or review? Yes ___ No ___

Has your contract in a prior position ever been non-renewed? Yes ___ No ___

Have you ever not been nominated for re-employment in a prior position or ever

had your nomination for re-employment not be approved? Yes ___ No ___

Have you ever been charged with or investigated for sexual abuse or harassment

of another person? Yes ___ No ___

Have you ever been convicted of a crime (other than a minor traffic offense)? Yes ___ No ___

Have you ever had a professional license or certificate suspended or revoked in any

state, or have you every voluntarily surrendered, temporarily or permanently, a

professional license or certificate in any state? Yes ___ No ___

Has any court ever deferred, filed or dismissed proceedings without a finding of

guilty and required that you pay a fine, penalty or court costs and/or imposed a

requirement as to your behavior or conduct for a period of time in connection with

any crime (other than a minor traffic offense)? Yes ___ No ___

If you have answered YES to any of the previous questions, provide full details on an additional sheet including, with respect to court actions, the date, and offense in question, and the address of the court involved. Conviction or other disposition of a crime is not necessarily an automatic bar to employment.

How many days have you missed from work during the past two years? ____________________

PERSONAL STATEMENTS - As a means of learning more about you, the Board requests that you respond to the questions below. Please answer the questions directly and cite examples to support your positions. Responses should be limited to two pages.

1. Describe two significant contributions, which you have made in your present or a past position, along with the process by which they were accomplished.

2. As a school’s educational leader, how do you determine the needs and priorities for your school and effect change to address those needs and priorities?

REFERENCES: List three, two of whom are most recent supervisors, who can comment on your professional ability and whom we may contact. In addition, please provide three letters of reference from persons who are not related to you (may be from references listed below).

Name

Position

Address

Phone

My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize those persons, agencies or entities that the M.S.A.D. No. 64 contacts in connection with my employment application to fully provide the M.S.A.D. NO. 64 any information on the matters set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the M.S.A.D. No. 64, its agents or officials, or against any provider of such information.

I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include board members, administrators, other staff, and members of the community. I give my consent to this disclosure.

Signature _________________________________ Date _____________________

APPLICATION FOR PRINCIPAL POSITION CHECK LIST: The completed employment application can not be evaluated unless of the following materials have been provided:

____ Letter of application explaining why you would like to be Principal of

Central Middle School

____ Fully completed and signed application form (please provide all requested information even though it may be duplicated on your resume.)

____ Copies of transcript(s)

____ The two personal statements requested in this application

____ Copy of Maine principal certification(s)

____ Current Resume

____ Gaps in employment during the past ten years explained

____ YES to any of the questions in the Background section explained

____ Three current letters of reference and names of two most recent supervisors who may be

contacted

NOTE: All application materials become the property of the M.S.A.D. No. 64. None will be returned. Providing any false or misleading information on this application or in the application or employment screening process shall be fully sufficient grounds to refuse to employ the applicant or, if the applicant has been employed, to immediately dismiss the applicant/employee.

Rev. 4/9/09