HTML Preview School Admin Job Application Form page number 1.
Application of ________________________________________________________________________________
Last Name First Name Middle Name
Present Address _______________________________________________________________________________
Street City State Zip
Phone Number (include area code) ___________________________________________
Permanent Address _____________________________________________________________________________
Street City State Zip
Phone Number (include area code) ______________________________________
Administrative Position Sought ______________________________________ Availability Date _____________
I. Education
A. College or University Dates of Attendance Degrees or Credits
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
B. Fields Major Hours Minor Hours
1. Undergraduate ________________________________________________________________
2. Graduate _______________________________________________________________
C. All Certificates Held and Subjects of Certification: ( please provide copies)
1. Permanent Provisional Initial Professional
___________________________________ ___________________ _____________________
Area Date Issued Expiration Date
2. Permanent Provisional Initial Professional
___________________________________ ___________________ _____________________
Area Date Issued Expiration Date
3. Permanent Provisional Initial Professional
___________________________________ ___________________ _____________________
Area Date Issued Expiration Date
If you do not have an SAS/SDA Certificate, have you applied for one? Yes No
If certified in another state, please describe. ___________________________________________________
Other licenses held: type and issuing authority __________________________________ Exp. Date _____
(please provide copies)
Lyons Central School District
Mission Statement
The Lyons Central School District, including its entire staff and
community, is dedicated to the education of the total student.
Together, we are committed to the development of the students’
academic, emotional, social and physical well being. Our
educational system supports the individual student as a whole
person and affords students the opportunity to develop their
potential to become productive, responsible members of society.
Administrative
Application
for
Lyons Central
School District