1. Healthcare

Application for the Position of Superintendent of Schools
King and Queen County Public Schools
1.
Name
(Last)
2.
(First)
Home Address
(Middle)
Business Address
(Street)
(Street)
(City)
(State)
(City)
(Zip)
Number
(State)
(Zip) Telephone
Telephone Number
Social Security Number
Email
3.
Preferred Mailing Address: Home
Business
4.
Present Position
5.
School District or Organization
6.
If a school district, please provide the following information
Size of district’s annual budget
No. of Non-certified Staff
Current student enrollment
7.
No. of teachers
No. admin./supervisory personnel
No. of schools
If other than a school district, please provide the following information
Size of budget for which responsible
No. employees/organization
Number of persons reporting to you personally
8.
EMPLOYMENT HISTORY (please list all full-time positions held within the field of
education)
Organization and Location
Position
Salary
From/To No.of years Size of Unit
Total No. of Years
Please attach an additional sheet to complete, if necessary.
9.
Have you ever been involved in or initiated a Court Suit especially if it relates to your
employment or employees?
Yes
10.
No
PROFESSIONAL PREPARATION: (Please list both undergraduate and graduate
matriculation in chronological order.)
Institution
Location
Major/Minor
Degree
Date of Degree
Please attach an additional sheet to complete, if necessary.
*Are you eligible for certification as a superintendent in the Commonwealth of Virginia?
YES [ ] NO [ ]
If you are in doubt about your status, contact Ms. Patty S. Pitts, Associate Specialist, Office of Professional
Licensure, State Department of Education, P.O. Box 6-Q, Richmond, VA 23216-2060; Telephone at (804)
225-2022.
11.
PROFESSIONAL MEMBERSHIPS:
approximate length of membership.)
(Please
list
names
Please attach an additional sheet to complete, if necessary.
12.
COMMUNITY AND CIVIC MEMBERSHIPS:
Please attach an additional sheet to complete, if necessary.
of
organizations
and
13.
HONORS AND AWARDS:
Please attach an additional sheet to complete, if necessary.
14.
PERSONAL PUBLICATIONS: (Please attach a list of the most significant and relevant
books or articles you have written and published.)
15.
AREAS OF HIGHEST DEMONSTRATED COMPETENCE: (Please rank in order of
competence based upon experience or specialization in undergraduate and graduate
preparation.)
Adaptability
Business Management
Comprehensive Planning
Curriculum/Instruction
Employee Relations
General Administration
Special Education
Vocational Education
Management of Growth
Personnel Management
Public Relations
Staff Development
Supt./Board Relations
Other (Specify below)
Please attach an additional sheet if you wish to elaborate.
16.
Using a separate sheet of paper, please discuss your foremost motivation in seeking
this position.
17.
REFERENCES: (Please list the names of not less than four (4) persons who are most
familiar with your work and qualifications.)
NAME
1.
POSITION
PRESENT ADDRESS
TELEPHONE NUMBER
2.
3.
4.
18.
INFORMATION ABOUT THIS POSITION VACANCY WAS RECEIVED FROM:
(NAME)
(ADDRESS)
I have requested a copy of my credentials from the following institutions:
1.
2.
3.
19.
SIGNATURE:
DATE:
Finalists may be asked to submit a video tape/DVD of themselves presiding or
presenting during a school board meeting, PTA meeting or other mass meeting in the
community. Finalists may also be asked to provide a copy of their most recent evaluation
by their school board and/or immediate supervisor.
Applications and supporting materials should be submitted on or before February 12,
2015. Applications will be accepted and reviewed until the position is filled.
Mr. Larry Horsley, Chair
King and Queen School Board
PO Box 42
King and Queen CH, VA 23085
King and Queen County Public Schools is an Equal Opportunity Employer
FOR OFFICE USE ONLY
Date application received
Transcripts received
Acknowledge
Credentials received
Reference requested
References received