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
