PRINCE WILLIAM COUNTY PUBLIC SCHOOLS - DOC

Document Sample
PRINCE WILLIAM COUNTY PUBLIC SCHOOLS - DOC Powered By Docstoc
					                                                                                                                           Revised: November 17, 2009




                                                       Administrative Applications Office
                                                    P.O. Box 389 - Manassas, Virginia 20108
                                                     (703) 791-8959 - FAX (703) 791-8033
TO THE APPLICANT:

         Thank you for expressing an interest in an administrative position in the Prince William County School Division. The
application procedure is outlined below. Please read these instructions carefully before completing the application.

Application Procedure

        Individuals interested in an administrative position must first establish an interview file in the Department of Human
Resources office. This file must include:

    Completed application for employment, including transcripts
    Two confidential letters of professional reference from individuals who have supervised the applicant in a work environment,
     including present supervisor
    Current resume
    Signed Background Investigation Consent Form
    Copy of teaching/administrative certificate(s) held

References

        References should include the name of at least one superintendent, assistant superintendent, principal and/or other official in
each school district where you have been employed. A reference from your most recent school system employer is required.

         Please be aware that while non-confidential letters of reference may be forwarded with your application, they do not take the
place of confidential reference forms required for the interview file.

Fingerprinting/Background Investigation

         Virginia law requires that all persons who accept a position with the Prince William County Public Schools be fingerprinted
for the purpose of conducting a criminal background investigation. If you are offered a position, you will be notified of the time and
place to complete the procedure.

         The Department of Risk Management & Security will also conduct a background investigation of all applicants for
management positions. This will include verification and examination of an applicant’s references, employment history, character,
financial responsibility, attendance, alcohol or substance abuse involvement, etc. The background information will be obtained
through interviews with previous employers, inspection of personnel records, interviews of references, interviews of neighbors and
fellow employees, and other appropriate sources.

Application Update/Renewal

         ALL APPLICATIONS ARE VALID FOR A PERIOD OF ONE YEAR. It is the applicant’s responsibility to keep his/her
interview file up-to-date. All interview files must be updated annually by January 1.

Further Information

           If you need further information, please call Ms. Theresa Field at (703) 791-8959.

As required by federal laws and regulations, the Prince William County School Board does not discriminate on the basis of sex, race, color, religion, handicapping
condition, or national origin in employment or in its educational programs and activities.
                   PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
                                                            P.O. BOX 389
                                                      MANASSAS, VIRGINIA 20108
                                                           (703) 791-8959

                                    APPLICATION FOR MANAGEMENT EMPLOYMENT



Full Name:
                        (Last)                                              (First)                                               (Middle)

Other Name(s):
                                (Please provide any additional information relative to change of name, use of an assumed name, or nickname.)

Present Mailing Address:
                                           Street                                     City                             State                 Zip

Permanent Mailing Address:
                                           Street                                     City                             State                 Zip

Telephone Numbers:
(       )                                              (         )                                          (          )
            (home)                                                   (permanent)                                        (work)

E-Mail Address:

Social Security Number
(Note: Completion of number is optional. Failure to submit social security number on this form will not prohibit employment consideration. Social security
number may be required on other forms prior to employment)

    My signature below authorizes the school division to conduct a background investigation and authorizes release of information in connection with my
application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and
educational institutions, personal references, professional references, and other appropriate sources. I waive my right of access to such information, and
without limitation hereby release the school division and the reference source from any liability in connection with its release or use. This release includes the
sources cited above and specific examples as follows: the local Sheriff, information from the Central Criminal Records Exchange of either data on criminal
convictions or certification that no data on criminal convictions are maintained, information from the Virginia or other State Department of Social Services
Child Protective Services Unit and any Locality to which they may refer for release of information pertaining to any findings of child abuse or neglect
investigations involving me.
            Furthermore, I certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be
relied upon in considering my application, and I understand that any omission, false answered statement made by me on this application, or any supplement
to it will be sufficient grounds for failure to employ or for my discharge should I become employed with the school division.

DATE:                                        SIGNATURE:


                                         INDICATE POSITION(S) YOU ARE APPLYING FOR
                                              List preferences by 1st, 2nd, and 3rd choice

                                                              ELEMENTARY                           MIDDLE                          HIGH
            ASSISTANT PRINCIPAL
            PRINCIPAL

                                                                                                       JOB TITLE
            OTHER MANAGEMENT POSITION
I. EDUCATIONAL AND PROFESSIONAL TRAINING (List chronologically)


     Name of College University   State     Field of Study       Degree     Year    Dates of Attendance




II. TEACHING EXPERIENCE

       Name of School             School Division        State    Grade/subject taught       Dates




III. AMINISTRATIVE EXPERIENCE

       Name of School             School Division        State            Level              Dates
IV. WORK OTHER THAN EDUCATION

                Employer                                             Address                              Kind of Work                Dates




V. CERTIFICATION

Educational Licenses(s) Held:

      State                                     Type                                                           Endorsement




VI. REFERENCES

Please submit below the names of at least three references which must include current employer if employed, or last employer if not currently
employed. It is the applicant’s responsibility to request the reference to complete the forms provided with the application. Additional statements and
references are welcome.

      Name of Reference                          Title                      Organization Mailing Address                        Telephone Number




VII. GENERAL INFORMATION

  Date available for employment:

  Are you currently under contract in another school division?                         □ Yes □ No      School Div:

  Have you ever been refused tenure of a continuing contract?                          □ Yes □ No      School Div:

  Have you ever held a continuing contract in another school division?                 □ Yes □ No       In Virginia? □ Yes     □ No

  Are you legally authorized to work in the United States on a full-time basis?        □ Yes □ No

  Have you ever been discharged or requested to resign from a position?                □ Yes □ No (If yes, explain on back.)

  Are any criminal charges or proceedings pending against you?                         □ Yes □ No (If yes, explain on back.)

  Have you ever been convicted of any offense involving the sexual molestation, physical or sexual abuse or rape of a child?    □ Yes □ No
  (If yes, explain on back.)
VIII. OTHER INFORMATION

To avoid conflict of interest, list any local school board member or employee relative(s) in the school division and cite relationship.




IX. REFERRAL SOURCE

  □ Newspaper/Magazine                        □ Job Fair                       □ Friend                         □ PWCS Employee

  □ Internet (Specify Site)                                                    □ Campus Interview               □ Other




The Prince William County School Board does not discriminate in employment or in its educational programs and activities against qualified individuals with
disabilities nor on the basis of age, gender, race, color, religion, or national origin.
In your own handwriting, provide any additional information you desire that will afford an additional understanding of your qualifications.




ADDITIONAL REMARKS AND/OR EXPLANATIONS FROM SECTION VII
            PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
                                  Administrative Applications Office
                                            P.O. Box 389
                                     Manassas, Virginia 20108
                                           (703) 791-8959


TO:    Associate Superintendent for Human Resources
       Prince William County Public Schools


1.     I wish to be considered for the following positions(s):

                Elementary Assistant Principal                     Elementary Principal

                Middle School Assistant Principal                  Middle School Principal

                High School Assistant Principal                    High School Principal

                Other
                                              (Job Title)

2.     I have attached a current resume, cover letter and copies of transcripts.


3.     I have asked two immediate supervisors/administrators to send Confidential References
       (form provided as part of the application process) to:

                         Keith J. Johnson
                         Department of Human Resources
                         Prince William County Schools
                         P.O. Box 389
                         Manassas, Virginia 20108




Name (please print)                                                  Social Security Number



Street Address



City                                                 State                                   Zip
                   PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
                                       Confidential Reference Form

Person Completing Form:          Name: ___________________________________
                                 Address: ___________________________________
                                 City:    ___________________________________
                                 Telephone: ______________(H)_______________(W)
                                 Email: ____________________________________

___________________________is an applicant for the position of __________________
in the Prince William County School Division. The information that you provide will help us make important
decisions concerning this position.
1. In what capacity did you work with this applicant? ____________________________
2. How long did the applicant work for you?___________________________________
3. Please evaluate the candidate to the best of your knowledge with respect to the following factors:
                               (High) 5 4 3 2 1 (Low)                     Remarks
1. Instructional Leadership
2. Administrative Functioning
3. Problem-Solving Ability
4. Human Relations
5. Planning and Preparation
6. Attention to Detail
7. Oral Communication
8. Written Communication
9. Attendance & Work Ethic
10. Creativity

4. What do you believe to be the applicant’s greatest strengths?___________________________
______________________________________________________________________________

5. What do you believe to be the applicant’s greatest area for growth or improvement?________
______________________________________________________________________________

6. On a scale of 1 to 10 (low to high), how would you compare the applicant to other applicants
you have worked with?___________________________________________________________

7. If you had an administrative opening, would you fill the vacancy by hiring this applicant?
______Yes ______No. And your reason?___________________________________________
______________________________________________________________________________

8. Can you think of anyone else who would be important for us to contact before making an
employment decision regarding this applicant?_________________________________________
______________________________________________________________________________

9. Any other information you would like to share about this applicant? (use back side if needed)
_____________________________________________________________________________

10. Is there any reason this candidate should not be hired?_______________________________

____________________________             _____________________            ___________________
Signature of Person Completing Form              Title                             Date

              Return to: Keith J. Johnson, Associate Superintendent for Human Resources
  PWCS · P.O. Box 389 · Manassas, VA 20108               FAX: 703-791-8033
                         PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
                                              Confidential Reference Form

Person Completing Form:          Name: ___________________________________
                                 Address: ___________________________________
                                 City:    ___________________________________
                                 Telephone: ______________(H)_______________(W)
                                 Email: ____________________________________

___________________________is an applicant for the position of __________________
in the Prince William County School Division. The information that you provide will help us make important
decisions concerning this position.
1. In what capacity did you work with this applicant? ____________________________
2. How long did the applicant work for you?___________________________________
3. Please evaluate the candidate to the best of your knowledge with respect to the following factors:

                             (High) 5 4         3    2   1   (Low)         Remarks
1. Instructional Leadership
2. Administrative Functioning
3. Problem-Solving Ability
4. Human Relations
5. Planning and Preparation
6. Attention to Detail
7. Oral Communication
8. Written Communication
9. Attendance & Work Ethic
10. Creativity

4. What do you believe to be the applicant’s greatest strengths?___________________________
______________________________________________________________________________

5. What do you believe to be the applicant’s greatest area for growth or improvement?________
______________________________________________________________________________

6. On a scale of 1 to 10 (low to high), how would you compare the applicant to other applicants you
have worked with?___________________________________________________________

7. If you had an administrative opening, would you fill the vacancy by hiring this applicant?
______Yes ______No. And your reason?___________________________________________
______________________________________________________________________________

8. Can you think of anyone else who would be important for us to contact before making an employment
decision regarding this applicant?_________________________________________
______________________________________________________________________________

9. Any other information you would like to share about this applicant? (use back side if needed)
_____________________________________________________________________________

10. Is there any reason this candidate should not be hired?_______________________________

____________________________             _____________________            ___________________
Signature of Person Completing Form              Title                             Date

                       Return to: Keith J. Johnson, Associate Superintendent for Human Resources
                        PWCS · P.O. Box 389 · Manassas, VA 20108              FAX: 703-791-8033
                                       ADDENDUM TO QUESTIONS VII GENERAL INFORMATION


As a condition of employment, Section 22.1-296 of the Code of Virginia requires that all applicants for employment respond to the questions below.

PLEASE NOTE: Any person making a materially false statement regarding any such offense shall be guilty of a Class I
misdemeanor and upon conviction, the fact of said conviction shall be grounds for the Virginia Board of Education to revoke such
person’s license to teach.

1.         Have you ever been convicted of a felony?                         YES                              NO

2.         Have you ever been convicted of any other
           crime other than a minor traffic violation?                       YES                              NO

3.         Have you ever been convicted of a crime of
           moral turpitude? (A crime of moral turpitude
           is lying, cheating or stealing)                                   YES                              NO

4.         Have you ever been convicted of any offense
           involving the sexual molestation, physical
           abuse or rape of a child?                                         YES                              NO

5.         Have you ever been the subject of a founded
           case of child abuse or neglect?                                   YES                              NO

6.         Have you ever been discharged or requested
           to resign from a former position?                                 YES                              NO

7.         Have you ever been refused renewal of a
           teaching contract?                                                YES                              NO

If you responded “yes” to any of the above questions, please include a statement of explanation on the last page of the application.



Print Name                                                                              Social Security Number


Signature                                                                               Date


THIS FORM MUST BE SIGNED, DATED, AND RETURNED WITH THE EMPLOYMENT APPLICATION.
                                      BACKGROUND INVESTIGATION
                                         RELEASE AND WAIVER

I,                                         , do hereby authorize and request that you make available to any duly authorized

representative of the Prince William County Public School Division, information concerning my background, employment

history, personal character, a criminal history, and credit and financial history. This is in connection with my application for

employment with the Prince William County Public Schools.



                                           SIGNED:

                                           DATE:

                                           WITNESS:



(PLEASE PRINT)

Name                                                           Soc. Security

Current Address




Previous Address




NOTE: FORM MAY BE WITNESSED BY ANYONE THE AGE OF 18 OR OVER.

        APPLICANT WILL NOT BE CONSIDERED FOR POSITIONS UNLESS

        THIS FORM IS COMPLETED AND RETURNED.



FORM NO. 7530-0241 (4/92)

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:40
posted:8/9/2012
language:Latin
pages:11