Application_ Fillable Administrator with ... - Silver Falls School District

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802 Schlador Street
Silverton, OR 97381
Phone: (503) 873-5303 | Fax: (503) 873-2936


                                                      July, 2009

1.     Goal: The goal of this procedure is to employ and assign qualified individuals to fill vacancies in
       Silver Falls School District 4J.

2.     Job Opening Notifications: As an administrator vacancy develops or is anticipated, it is advertised
       to probationary and permanent district administrators and, as necessary, publicly.

3.     Application Procedure: Applications will be accepted by the District Office from any individual
       who is eligible for a valid Oregon administrative license.

       In order to be given full consideration for employment, a complete current application must be on file
       which would contain the following:
        -     Completed online EdZapp application. The Educator’s Resource for Employment website:
        -     Completed Silver Falls School District Administrator Application mailed or hand delivered
              to address above with following application materials:
               -       Employee Background Information Form
               -       Current resumé
               -       Current recommendation letter from most recent supervisor,
               -       Two additional letters of reference,
               -       Unofficial transcripts (unless hired, then official transcripts)
               -       Copy of current (not expired) Oregon administrative license with appropriate
                       endorsements for position applied.

4.     Qualifications and Eligibility
       4.1     License to Administrate in Oregon: Having a valid Oregon administrator license,
       appropriate to the assignment, is required to hold an administrative position in the Silver Falls School
       District. An offer of employment will be made only to an individual who possesses a valid Oregon
       administrative license appropriate for the assignment. Any applicant who does not hold a current,
       valid Oregon administrative license, should contact the License Section, Teacher Standards and
       Practices Commission, State of Oregon, 255 Capitol St. NE, Salem, Oregon 97301 (telephone 503 -
       378-3586), to determine eligibility for an administrative license in Oregon.

       Each applicant is requested to notify the District Office in writing of any change in status or address.
     4.       Qualifications and Eligibility – cont.

     4.2 Employment Eligibility Verification: The Immigration Reform and Control Act of 1986
     requires all employers in the United States to hire only American citizens and aliens who are
     authorized to work in the United States. If you are employed by Silver Falls School District, you will
     be required to complete an Employment Eligibility Verification (Form I-9), and to provide a
     current document or documents that establish your identity and employment eligibility before you
     report to work. These documents are listed on the back of the I-9 form and establish both identity
     and employment eligibility. These documents appear in List A below. Other documents establish
     identity alone (List B) or employment eligibility alone (List C). If you cannot provide a document
     from List A, then you must produce one from List B and one from List C.

     List A
     1.       United States Passport
     2.       Certificate of U.S. Citizenship
     3.       Certificate of Naturalization
     4.       Unexpired foreign passport with attached Employment Authorization
     5.       Alien Registration Card with photo

     List B                                     List C
     1.     A state-issued driver's license or         1.        Original Social Security Number
            photo, or information including                      Card (other than a card stating
            name, sex, date of birth, height,                    it is not valid for employment
            weight, and color of eyes. (Specify        2.        A birth certificate issued by a
            state _____________________________                  state, county, or municipal
     2.     U.S. Military Card                                   authority bearing a seal or
     3.     Other (specify document and issuing                  other certification
            authority)                                 3.        Unexpired INS Employment

5.   Screening, Interviews, and Selection: An applicant who has a complete application file will have
     his/her file reviewed by the Superintendent), and/or designee(s). Preliminary interviews of screen
     finalists are normally held before a team of administrators, staff members and patrons. Finalists are
     selected and normally interviewed a second time by the Superintendent and/or designee. The
     Superintendent will then make a final recommendation for employment to the school board.

6.   Criminal History Verification: All applicants are to fill out the district Employee Background
     Information form as part of the application procedures. This information will be used for district
     background checking purposes for all applicants considered for employment.
                                    Silver Falls School District 4J
                               Employee Background Information Form
You must respond to each question with accurate and honest information. Failure to provide information or
providing inaccurate information may result in the denial of your application. If you are already employed
and it is determined that you have provided incomplete or inaccurate information, this determination may
result in your termination as an employee.

Please type your full and complete name including middle name:

Date of Birth:           Driver’s License Number:

Place of Birth (City & State):

List any other names you have used including maiden name if one:

Name:            Name:           Name:        Name:       Name:

Your home address:

Home Phone:              Other Ph. #:

List any other States you have lived in other than Oregon and the times in which you lived there: (If
additional space is needed, use the Comments section on next page)

State:        Year(s):

State:        Year(s):

State:        Year(s):

State:        Year(s):

Have you ever been arrested for or charged with a crime?     Yes      No
 *Note* Actions taken by you or by others on your behalf, to Expunge, Set-Aside or clear records of arrest
or prosecution Does Not remove your obligation to respond honestly to this question. (If additional space is
needed, use the Comments section on next page).

Crime:           Year:         Location (City & State):

Crime:           Year:         Location (City & State):
Have you ever been under Court Order prohibiting your contact with a person or place, such as a Restraining
Order, Stalking Order or a “No Contact” Order?    Yes      No

If Yes, what was the nature of the action and where and when did this take place?

Nature (such as Restraining or Stalking Order):         Location (City & State):         Year:

Nature (such as Restraining or Stalking Order):         Location (City & State):         Year:

Have you ever had your driving privileges revoked or suspended in this or any other state?       Yes      No

Reason why Suspended or Revoked:              Location (City & State):        Year:

Reason why Suspended or Revoked:              Location (City & State):        Year:

Comments - is there any information that you wish the District or its representative to consider regarding any
of your responses on this document or about any information that will be discovered during the

(Type your name on first line and sign and date at the bottom of this authorization for release of information)

I       , state that all the information on this form is accurate and complete and is provided in good faith.
Through my signature below I authorize the Silver Falls School District, Willamette Education Service
District and their representatives to investigate this information. Further, with my signature I give
irrevocable consent to all governmental agencies, public or private companies and individuals to release
information regarding me to Silver Falls School District.

_______________________________________                      _______________________
Signature                                                    Date
                                               ADMINISTRATOR APPLICATION
 SILVER FALLS SCHOOL DISTRICT 4J                                                                            Administration Office
Phone: (503) 873-5303                                                                                       802 Schlador Street
FAX: (503) 873-2936                                                                                         Silverton, Oregon 97381
Internet Address:

Reasonable accommodations will be made when needed by applicant to complete this application. Silver Falls School District complies with
provisions of the various civil rights laws, such as the Fair Employment Practices Act, Title IX Regulations, Americans with Disabilities Act, and
Section 504 of PL 93.112 in employment and educational programs and activities .

Name:                E-Mail Address:
Address: Street              City           State          Zip

Home Phone:                    Work Phone:
Administrative Position Applied For:
Oregon Administrative License: Endorsement(s):
                                               Authorization Levels:
University Undergraduate GPA:                           University Graduate GPA:
                                                        Application Instructions
In order for your application to be complete, you must complete the online EdZapp application, employee background
information form, and this application. Please provide current resume, recommendation letter from most recent
supervisor, two additional letters of reference and copy of transcripts. Also provide a copy of current (not expired)
Oregon Administrative License with appropriate endorsement and authorization level for position applied.

Have you ever been employed by an education provider?      Yes      No If yes, please complete top portion of
‘Sexual Conduct Disclosure Release’ (to follow) for each of the three most recent education providers and
return with application

NOTE: This application will not be considered if this application and the above required documents are incomplete.
Please refer to administrator employment procedure (inside) for application details. SIGNATURE LINES MUST BE

Applications remain active for one year. They are kept on file for three years and then destroyed. You may reactivate
a file within that three year period by phoning the District Office or by sending updated information.
I understand that criminal history checks are required by law and board policy. Any fees associated with criminal
history records checks and fingerprinting, not to exceed actual costs, shall be the responsibility of the individual.

I authorize Silver Falls School District to check my references and to investigate any information provided in my
application for employment. I further authorize my past employers or anyone with information about my work history,
education or qualifications to provide such information to Silver Falls School District in response to their inquiry. I
agree to hold harmless from any liability (suit, claim or other action) anyone supplying such information to Silver Falls
School District.
The facts set forth on this application for employment are true and complete to the best of my knowledge. I understand
that if employed, false statements on this application shall be considered sufficient cause of immediate termination.
_____________________________________________________________                            _____________________________________
Signature                                                                                Date
Candidate’s Statements: The following questions are designed to help the Silver Falls School District
know you as a person and as a professional. Your concise and candid responses are very important to us.

   1. What makes you a strong candidate for this position? Include the form(s) of leadership you will

   2. What do you consider to be your major strengths as an administrator and what areas do you need to

   3. What is the primary function of a school administrator?

   4. What is the value you place on professional collaboration? Please describe examples that you have

   5. There are many contemporary issues in education. Please describe one or two of these issues, your
      understanding of how they apply to your leadership skills as an administrator and how you would
      begin to address the issues as a school administrator.

Have you ever had a professional certificate, credential or license (of any kind) revoked or suspended or
have you been placed on probationary basis for any alleged misconduct or alleged violation of professional
standards of conduct?                                                                    Yes         No

Have you ever been investigated by Teacher Standards & Practices Commission?             Yes            No

__________________________________________________________                  _____________________
Signature                                                                   Date

  The Silver Falls School District is 240 square miles in
  size and located in Marion and Clackamas Counties at
  the east edge of the rich and beautiful Willamette Valley.
  Much of the district is nestled in the western foothills of
  the Cascade Mountains. In the center of the district lies
  the community of Silverton, 14 miles from the Silver
  Falls State Park, 42 miles south of Portland, and 14 miles
  east of Salem, Oregon’s capital. Silverton is noted for
  many estate style homes on tree shaded streets and Silver
  Creek running through its downtown core. Silverton has
  police and fire departments, a library, a nationally
  recognized hospital, and many businesses serving the
  entire Silver Falls District area.

  North and east of Silverton lie the communities of
  Monitor, Marquam (Butte Creek School), and Scotts
  Mills. Monitor includes a rural fire station, general store,
  and several businesses including the Monitor Telephone
  Company. Marquam includes the MarKum Inn and
  Marquam Methodist Church.             Scotts Mills is an
  incorporated city that includes a rural fire station, general
  store, post office, and several businesses.

  South and west of Silverton are the communities of Drakes Crossing (Silver Crest School), Victor Point,
  Evergreen, Pratum, Central Howell, and Bethany. Drakes Crossing, Pratum and Victor Point include rural fire

  Each of the District’s rural communities has a K-8 elementary school. Within the city of Silverton are three larger
  schools: Eugene Field Elementary (K-3), Robert Frost (4-6), and Mark Twain Middle (7-8). Each of the rural
  schools and Mark Twain Middle School feed into Silverton High School. It is also located in the city of Silverton
  and offers a solid breadth of curriculum highlighted by programs in agricultural sciences, business education, fine
  and performing arts, and technology. The school also hosts a variety of extra-curricular activities including clubs,
  sports and student government. The old high school was replaced with a new high school in 2009.

  The economy within the School District is diversified. Agriculture is the largest local industry and includes
  production of Christmas trees, grass seed, sod, berries, vegetables, nursery plants, forest and a variety of livestock.
  There are some small industries as well as retail stores and restaurants in and adjacent to Silverton. Many
  residents are employed in Salem or the Portland metropolitan area. Higher education opportunities are also
  available in nearly communities. Numerous two-year public colleges and four-year public and private universities
  are within easy driving distance of Silverton.

  Recreation is a feature point of the area. Silverton has a city park, municipal swimming pool, tennis
  courts, movie theater, bowling center, and an organized summer youth recreation program. Also close by
  is the Evergreen Golf Course, Silver Falls State Park (Oregon’s largest state park), and the Oregon
  Garden (a botanical garden that showcases Oregon’s nursery industry). The Moonstone Resort is located
  within the Oregon Garden, and it includes lodging, conference rooms and a restaurant. An hour’s winter
  drive in one direction brings you to snow and skiing in the Cascade Mountains. In the summer, hiking,
  fishing and camping are available. An hour-and-a-half drive in the opposite direction brings you to the
  Oregon beaches.
                                         SILVER FALLS SCHOOL DISTRICT
                                      SEXUAL CONDUCT DISCLOSURE RELEASE

Applicant: Complete top portion only, sign and date and return with application. We will mail if considered for


         CITY, STATE, ZIP:

The applicant named below is under consideration for employment in our district. This individual has previously been employed
with your organization. As a former employer, we request you provide the information requested on this form within 20 business
days pursuant to ORS 339.374.




I authorize you to release to the Silver Falls School District all information related to any substantiated reports of child abuse, sexual conduct, or
crimes listed in ORS 342.143. I release the above employer and employees acting on behalf of the employer from any liability for providing
information described in this document.

Applicant Signature                                                                                        Date

  This section to be completed by previous employer only.

  Dates of employment:   ___________ ___________
                         From             To
  The employee       was          was not the subject of any substantiated reports of child abuse or sexual conduct related to the
  applicant’s employment with the education provider.

           ● Dates of any substantiated reports:

           ● Please attach the definitions of child abuse and sexual conduct used by the District when the
             education provider determined that any reports were substantiated and the standards used by the
             District to determine whether any reports were substantiated.

  Former Employer Representative Signature                                                      Date

  Printed Name                                                                                  Job Title

Return completed information to:

TELEPHONE: 503-873-5303 FAX: 503-873-2936

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