Dear Applicant: This letter is to acknowledge receipt of your resume or on-line application and to thank you for expressing interest in working in our school district. We require an application form, a college credential file or three letters of reference, official transcripts, and proof of certification. We request that you complete the application in as detailed a manner as possible. Please return all materials quickly as your application will not be considered until it is complete.

Thank you for your interest. Sincerely, Melody Kajkowski Office of Certified Personnel Enclosure

Office of Certified Personnel

196 Main Street, New Paltz, New York 12561

Phone: (845) 256-4030 • Fax: (845)256-4027

www.newpaltz.k12.ny.us

New Paltz Central School District 196 Main Street

New Paltz, NY 12561 (845) 256-4000

APPLICATION FOR ADMINISTRATIVE

APPOINTMENT

DO NOT WRITE IN TIllS SPACE

ENCLOSURES:

CREDENTIAL ALE/ REFERENCES

TRANSCRIPTS OTHER ( )

FOLLOW-UP RECORD INITIALS DATE

APPUCATION ACKNOWLEDGED

INTERVIEW-SUPT. OF SCHOOLS

INTERVIEW-

INTERVIEW-

REFERENCES CONTACTED

VISITATION

APPOINTMENT OFFERED

APPOINTMENT ACCEPTED POSITION DATE TENURE TENURE

POSITION AREA DUE DATE BEGINS

Please type or print SCHEDULE STEP SALARY

D~e ________________________________ _

Nwne ______________ ~~~--------------------~~~--------------------------~=_--------ARST MIDDLE LAST

Admess ______________________________________________________________________________ _

_____________________ Telephone C-) ____________ _

Mailing Admess (if different from above ) _____________________________________________________ _

1. Please fill out this application accurately and completely, including certification information. Do not indicate "see resume" or "see vita."

2. Submit your college credential file or three letters of recommendation.

3. Interviews will be arranged by appointment.

4. Application and all supporting documents, including transcripts, copies of certification(s), resume, letter of application, and credential file or letters of reference, should be returned to the Personnel Office in order to be considered for the position.

New Paltz Central School District, 196 Main Street, New Paltz, NY 12561

ADMINISTRATIVE POSITION DESIRED Assistant Superintendent (Specify), ___________________________________________ _

Building Administrator (Specify)

Director or Coordinator (Specify) ___________________________________________________ __

Assistant Principal (Specify): _______________________________ _

Other (Specify) ________________________________ _

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job-related handicap. The District is interested in diversifying staff to

represent/reflect the cultural diversity of the community. Persons of color are encouraged to apply.

An Equal Opportunity Employer

CERTIFICATION INFORMATION

I hereby certify that I hold a teaching/administrative certificate issued by the University of the State of New York as follows: (Copy exact wording from certificate)

Title ofcertificate _________________ Form, _______________ _

PROVISIONAL, PERMANENT, INITIAL, PROFESSIONAL

Field validity ____________ Type ofSchool _________________ _

SUBJECT AREA OR AREAS ELEMENTARY, SECONDARY, DISTRICT

Valid from ______________ Issued to ____________________ _

DATE IF NAME WAS DIFFERENT

New York Certificate No. ________ ~Date Issued. ___________________ _

A candidate not officially certified to teach in the public schools of New York State outside of New York City should give the status ofhislher application, ifany, as follows (check one):

Application submitted to and approved by the NYS Department of Education, certificate forthcomingO-..-____ _

Application filed - decision pendine>.g-----______ ~Application not filed'--______ _

Other certificates held; type and issuing authority ______________________ _

Were you ever granted tenure in New York State? Yes No __

If so, what School District ____________ Date ofTenure. ____________ _

(please submit a copy of your tenure appointment letter or proof of previous tenure)

If you are a member ofNYS Teachers' Retirement System, please state your number __________ _

SCHOOLS ATIENDED

EDUCATION AND PROFESSIONAL TRAINING (Descending Chronological order)

DATESATIENDED MAJORS & MINORS DEGREE RECEIVED

CURRENT STATUS

CREDITS BEYOND LAST DEGREE

Most recent Professional Position. ______________________________ _

Salary ________________ What salary do you expect?---___________ _

Present position (if different) _______________________________ _

If you are now employed, why are you seeking a change? ______________________ _

When would you be available? _______________________________ _

Have you been fingerprinted? (If yes, provide a copy of clearance ) ____ _

DATES

DATES

DATES

ADMINISTRATIVE EXPERIENCE List in chronological order, most recent Administrative experience first

(include internship teaching if administrative experience does not total three years).

NAME OF LOCATION TITLE NO. YEARS SCHOOL

TEACHING EXPERIENCE NAME OF LOCATION TITLE NO. YEARS SCHOOL

WORK EXPERIENCE - Other than Education

FIRM OR INSTITUTION NATURE OF WORK

REFERENCES

LAST YEAR SALARY

LAST YEAR SALARY

NO. OF MONms

Give four references, including superintendents and principals under whom you have taught, who have first-hand knowledge of your

scholarship and administrative ability. Ifpresently employed, include your present employer.

NAME POSITION PRESENT ADDRESS TELEPHONE NO.

Please place an asterisk before those references we should not contact until you give permission.

I

Have you ever failed to be reappointed, denied tenure, or been discharged from a school position? ________ _

If so, please explain. _________________________________ _

Have you ever been convicted of a felony? ______ _

If so, please explain. _________________________________ _

PERSONAL DATA

What prompted your decision to make application in this School District? _________________ _

Have you ever interviewed at NPCSD? ___ If so, when and what building? _______________ _

What are your professional goals and/or future plans? ________________________ _

Significant professional achievements (articles, group leadership, offices in professional organizations, etc.). _____ _

Name and purpose of community organizations in which you have participated: _______________ _

What experience(s) have you had in working with diverse communities/populations? _____________ _

List any leadership experience you have had in cultural diversity: ____________________ _

How would you characterize your leadership style? _________________________ _

Please provide any information that will assist us in arriving at a fair estimate of your qualifications. ________ _

VERIFICATION

I hereby certify that the above information to the best of my knowledge is true, accurate and complete. Any misrepresentation or willful omissions of facts shall be sufficient cause for disqualification of this application or termination of employment. Furthermore, I hereby authorize the District to conduct work history and personal reference inquiries to determine my acceptability for employment. I acknowledge employment is subject to a fingerprint and criminal check.

Signature of Applicant

Date