Mechanicsburg Area School District
100 East Elmwood Ave
Mechanicsburg, Pa 17055
(717) 691-4500
Fax: (717) 691-3228
APPLICATION FOR ADMINISTRATIVE EMPLOYMENT
PERSONAL INFORMATION
Name: Date:
Home Address: Telephone Number:
City:
Telephone Number:
Business Address:
City:
Present Position:
Name of School District:
EDUCATION
Name of School Location Diploma Major Minor
High School
Undergraduate School
Graduate School
CERTIFICATION
Type Year Valid Area State
EXPERIENCE Educational-List in consecutive order
beginning with present position
Date Final May we
School and District from/to Type of Position Reason for Leaving Salary contact this
employer?
EXPERIENCE Non-educational- List in consecutive order
beginning with the most recent Position
Company’s Name Date Final May we
and Address from/to Type of Position Reason for Leaving Salary contact this
employer?
REFERENCES List the names of persons who know
you and your work
Name Title Address Telephone May we
contact this
reference?
(H)
(W)
(H)
(W)
(H)
(W)
(H)
(W)
(H)
(W)
(H)
(W)
HONORS AND DISTINCTIONS
List degrees, honors, awards commendations, elective or appointive offices held, or other distinctions received
Date Honor, Degree, etc. (include source, institution, etc. Comment if desired)
MEMBERSHIPS AND AFFILIATIONS
Educational and other
Organization Leadership Role Remarks
COMMUNITY ACTIVITIES
Specify community
ESSAY
Directions: In your own handwriting, please answer the questions below.
1. What special qualifications do you feel you have for this position? (Use additional sheet of paper if more space is needed to answer
questions.)
2. Please comment on the most significant contribution you have made in an administrative position:
3. Help us understand you better by telling us something of your personal interests and priorities:
I verify that all the statements on this application are true, complete and current. I further authorize the Mechanicsburg Area School District to
investigate all statements made on this application.
____________________ _____________________________
Date Applicant’s Signature
Should this application be treated as confidential with regard to your present employee?
The Mechanicsburg Area School District, an equal opportunity employer, will not discriminate in employment, educational programs or
activities based on race, religion, national origin, color or handicap. This policy of non-discrimination extends to all other legally protected
classification. Publication of this policy in this document is in accordance with state and federal laws including Title VI of the Civil Rights Act
of 1964, Title IX of the Education Amendments of 1973, and section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities
Act.
Inquiries should be directed to Deb Stouffer, Compliance Officer, Mechanicsburg Area School District, 100 E. Elmwood Ave., Mechanicsburg,
Pennsylvania 17055-4243