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ONLINE APPLICATION

School District:

Application for the Position of Superintendent

This application form will be used as a working document by the screening committee. Complete the entire form.
PERSONAL INFORMATION
Last Name: First Name: Middle:
Home Address:
City:
State:
Zip:
Home Phone: Preferred Email:
PRESENT EMPLOYMENT INFORMATION
Present Position/Title:
Employer Name/Address:
Dates of employment:
to
Student enrollment (if applicable):
Number of employees you supervise:
Annual budget:
Current annual salary:
Business Phone: Email:
PREVIOUS EMPLOYMENT HISTORY
List other full-time experience in reverse chronological order.
Position/Title Organization/Location/Grade Level/Enrollment Dates
Position / Title Organization Grade Level Dates
Location Enrollment From To
1.
2.
3.
4.
5.
EDUCATION
Institution Dates Attended Major/Minor Degree (Date)
1
2
3
4
5

REFERENCES
List the names of four persons who know of your professional work and qualifications.
Include the names of at least two school board members. Name Position Address Phone

Name Position Address Phone
Do you wish to place any restrictions on contacting these and other references?
If yes, explain:
Clicking the "Submit" button below authorizes Nothwest Leadership Associates and/or the school district to conduct a background investigation, including criminal convictions, driving records, previous employment, and personal references, as part of the application process. I hereby consent to the release all information related to this investigation, and release the school district from any liability in connection with the use of this information. I hereby certify that the information contained in this application and otherwise provided by me as part of the application process is complete and true. I understand that any false or misleading information provided by me will constitute sufficient grounds for disqualification of my application, or in the event that I am employed by the district, for my dismissal.