Pike Valley Unified School District N




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Pike Valley Unified School District No. 426


Box 291, Scandia, Kansas 66966

Phone (785) 335-2206

Fax (785) 335-2219


Application for High School Principal


Name _______________________________________________________________________

(Last) (First) (Middle Initial)

Present Address: Street ________________________________________________


City _________________________________State __________ Zip ________
Telephone _________________________________

Permanent Address: Street ________________________________________________

(if different than above)

City __________________________________State __________ Zip_________


Telephone _________________________________

Social Security Number _____________________________

Address Applications To: Pike Valley U.S.D. #426

Vicki Nylund, Clerk of the Board

P.O. Box 291

Scandia, KS 66966

Attn: High School Principal Application

Date of Candidate’s availability :_____________________


Date of Application:_____________________________

Opening Doors to Success


General Information


 Yes  No Are you Currently under Contract? If so when does your contractual obligation expire?

 Yes  No Are you now certified to be a High School Principal in Kansas?

 Yes  No Have you ever been refused a continuing contract? (If yes, explain below.)

 Yes  No Have you ever been discharged or requested to resign from a position?

(If yes, explain below.)

 Yes  No Have you ever been placed on probation? (If yes, explain below.)


Comments:

Security

 Yes  No Have you ever been convicted of a felony and/or served time for a felony in the past

seven years? (If yes, explain below.)

 Yes  No Have you ever been convicted of any crimes of moral turpitude or offenses involving

children, disabled, or the elderly?
Comments:

Educational/Professional Training




Educational Data





School Attended and Location

Inclusive Dates

Degree/Hours

Major Field

Workshops or Seminars

High School













College/University













College/University













College/University













College/University













College/University












Number of semester hours in major field: Undergraduate ____ Graduate _______


Number of semester hours in minor field Undergraduate ____ Graduate _______
College Honors and Activities

College Placement Bureau where your credentials are available.



Chronological Education Employment





Date

School District and Location/District Enrollment

Position/Duties

Annual Salary

Reason for Leaving





























































































References


List three character references who are not related to you and have known you for at least three years.

Name

Address/Telephone

Business




























Is it permissible to contact any or all of the references?
If no, after what date would it be permissible?

If you are a finalist for the position, is it permissible for the board to visit your current district?

Other Training or Experience Related to the Position Applying For


Description of Job

Name/Address of Company

Telephone Number

Dates Worked

Name of Supervisor




























































If selected and conditions prove satisfactory to you, do you have any plans which would prevent your administrative work in our school district for at least two years?

State briefly your reasons for wishing to be a Principal in our district.

Please mention here anything not included elsewhere in this application which you feel will further support your candidacy.

Candidate's Educational Statements
Please provide a brief narrative statement concerning your knowledge of management skill sin each of the following areas: Use the back if needed.


Professional Memberships relevant to position applied for.


What level of knowledge do you have in the area of the College and Career Readiness Standards?

I hereby certify that all information is true, accurate, and complete to the best of my knowledge. Any misrepresentation or willful omission of facts shall be sufficient cause for disqualification of this application or termination of employment. I hereby authorize Pike Valley U.S.D. #426 to conduct work history, personal references, and/or police record inquires to determine my acceptability for employment.

____________________________________________ ____________



Signature Date
Pike Valley U.S.D. #426 does not discriminate on the basis of race, religion, color, national origin, sex, age or handicap in admission or access to, or treatment or employment in its programs and activities.


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