Hazlehurst City School District Application for Superintendent of Schools Please type or print your responses and fully respond to each item. I. Basic Information Name (Last) (First) (Middle) Social Security # Home Address Business Address Phone Contacts: (Home) (Work) (Cell) E-Mail Address II. Current Employer Name Address Telephone Number When Does Your Current Contract Expire? III. Current Position Title Salary Hazlehurst City School District Superintendent Application / Page 1
IV. Current School District Information Briefly describe the school district or organization where you are currently serving, including the budget for which you are responsible: Budget: What is the total enrollment of the school district in which you are currently employed? What is the racial composition of the school district in which you are currently employed? % Black % Hispanic % White % Other Do you have current Mississippi superintendent s certification? q Yes q No Have you ever served in the United States military? q Yes q No If yes, were you honorably discharged? q Yes q No q NA V. Education Preparation Please list entries beginning with the most recent information. Degree Year Received College/University Years Attended Major Hazlehurst City School District Superintendent Application / Page 2
VI. References PROFESSIONAL List and give mailing addresses for three current references qualified to provide information about your professional ability and achievements. The mailing address should include the zip code. HAVE YOUR REFERENCES SEND THEIR LETTERS DIRECTLY TO DR. E. HAROLD FISHER, Superintendent Search Consultant, P. O. Box 2933, Ridgeland, MS 39158-2933. Name, Position Complete Address Phone / Email PERSONAL List and give mailing addresses for three current references qualified to provide information about your personal character. The mailing address should include the zip code. HAVE YOUR REFERENCES SEND THEIR LETTERS DIRECTLY TO DR. E. HAROLD FISHER, Superintendent Search Consultant, P. O. Box 2933, Ridgeland, MS 39158-2933. Name, Position Complete Address Phone / Email Hazlehurst City School District Superintendent Application / Page 3
VII. Employment History List entries in reverse order, beginning with your present position. Year(s) Employer Address & Phone Title or Assignment VIII. Other Have you ever been terminated, non-renewed or requested to resign from any position? q Yes q No If yes, please explain: Have you ever been convicted of, or pleaded no contest to, a felony or misdemeanor (other than traffic violations)? q Yes q No If yes, please explain: Hazlehurst City School District Superintendent Application / Page 4
IX. Leadership in the Profession and the Community List your current Mississippi administrator certification and when it expires ( School District requires a minimum AA 486 Administrator Certificate). List your successful experience as an administrator at the district and/or school level giving the positions and years served in each. List your years as a successful classroom teacher giving the grades and/or courses taught. Share evidence of your ability to develop and improve curriculum and instruction with emphasis on Common Core State Standards. Share your successful experience and understanding of financial planning, budget preparation and management at the district level. Give evidence of your experience in providing professional development for certified and classified employees at the district level. Share your documented track record of raising the achievement level of all students in the school district. Hazlehurst City School District Superintendent Application / Page 5
Share your experience in securing state, federal, and private grants. Give evidence of your high moral and ethical standards and conduct. Give evidence of your firm understanding of Mississippi s accreditation and accountability system. Share your successful ability to articulate the district s vision as well as carry out short and long range goals. Share your leadership style along with evidence of strong leadership ability. Record of working with others inside and outside the school district with emphasis on parental and community involvement. Share evidence of your ability to develop positive rapport with teachers, administrators, and other personnel in the school district. Hazlehurst City School District Superintendent Application / Page 6
Give evidence of your ability to develop a climate of trust and openness. Give evidence of your effective communication skills including speaking, listening, writing, and technology. Give evidence of an authentic love and genuine concern for students, their families, the district, and the community. Give evidence that you understand the value of community involvement and your ability to further develop and sustain the support of the community. List and describe the three most significant positions of professional leadership that you have held, with professional, state, regional, and / or national organizations. What do you consider to be your greatest strengths? X. Distinctions List and describe the three most significant recognitions, honors, awards, etc. that you have received (including dates). 1. 2. 3. Hazlehurst City School District Superintendent Application / Page 7
XI. Residency in the Hazlehurst City School District and Community The successful candidate must live in the Hazlehurst City School District. If selected, will you live within the Hazlehurst City School District and be involved in civic / community organizations? q Yes q No This application will not be considered complete without a signature. Your signature certifies that, to your best knowledge and belief, the information provided herein is complete and true. (Signature of Applicant) (Date) Please forward this application, along with a letter of interest, current resume, an official transcript from ALL colleges and universities that you attended, and a copy of your administrative license to: Dr. E. Harold Fisher, Consultant Hazlehurst City Superintendent Search P. O. Box 2933 Ridgeland, MS 39158-2933 Hazlehurst City School District Superintendent Application / Page 8