School District of Augusta

EDUCATION VISION STATEMENT

“Transforming the Path for Student Growth & Achievement”

ACTIVITIES & FACILITIES DIRECTOR APPLICATION

Each item on this application is important. Please complete carefully and accurately.

Date of Application: ______

Part I: PERSONAL INFORMATION

Last Name: ______First Name: ______M. I. ______

Present Address: ______

StreetCityStateZip

Permanent Address: ______

StreetCityStateZip

Present Phone #: ______

Additional Daytime Phone #: ______

Email: ______

Part II: GENERAL INFORMATION

Include a resume of qualifications with your application. College transcripts and three letters of recommendation must be provided by the applicant to insure consideration for an employment interview.

Position for which you are applying: ______

List other areas in which you are qualified or certified: ______

______

Date(s) available for employment: ______

Are you currently under contract: ______If yes, explain______

______

Have you filed an application with this district in the past?

______Yes______NoUnder what name? ______

When? ______

Part III: CERTIFICATION

If applicable, include a copy of your current teaching certificate with your application.

Area(s) ofState IssuingExpiration DateWI DPI

CertificationLicenseMonth/YearFile #

______

______

Student Teaching

Subject/CooperatingSchoolSemester

DatesGrade LevelTeacher(s)DistrictCredits Earned

______

______

Part IV: EDUCATIONAL AND PROFESSIONAL TRAINING

Please list in order of attendance all education institutions attended. Enter semester hours only.

UndergraduateCoursework Name of Institution Degree Major Minor GPA

______

______

GraduateCourseworkName of Institution DegreeMajor Minor GPA

______

______

Total number of Graduate Semester Credits earned above your highest degree.

______

Part V: PROFESSIONAL AND/OR EDUCATIONAL JOB EXPERIENCE

1)Inclusive dates of employment ______Assignment ______

Name and complete address of employer: ______

______

Name of immediate supervisor ______

Full or Part-time ______

2)Inclusive dates of employment ______Assignment ______

Name and complete address of employer: ______

______

Name of immediate supervisor ______

Full or Part-time ______

3)Inclusive dates of employment ______Assignment ______

Name and complete address of employer: ______

______

Name of immediate supervisor ______

Full or Part-time ______

4)Have you ever been non-renewed for reasons other than budgetary or program elimination? ______

Part VI: REFERENCES: INCLUDE YOUR MOST RECENT SUPERVISOR(S)

1)Name ______Title ______

Address ______Phone # ______

2)Name ______Title ______

Address ______Phone # ______

3)Name ______Title ______

Address ______Phone # ______

4)Name ______Title ______

Address ______Phone # ______

5)Name ______Title ______

Address ______Phone # ______

6)Name ______Title ______

Address ______Phone # ______

Part VII: PERSONAL STATEMENT ON EDUCATION

Please share your personal belief/philosophy on education:

______

______

______

______

Part VIII: ACTIVITIES & FACILITIES DIRECTOR QUESTIONARRE

Please answer the questions below to your best ability in 75 words or less:

  1. As a leader in our District, what do you see as your primary mission? ______
  1. What would be your greatest priorities as the director of activities and facilities in the Augusta Area School District?

______

  1. How would you go about building relationships with staff, students, parents, and community members?

______

  1. What would you identify as your greatest strengths as a leader?

______

  1. What role do you see for the activities and facilities director in district-based decision making?

______

  1. What do you see as the first step in initiating successful change?

______

  1. How would you establish/develop a collaborative environment with your staff? With the community?

______

  1. How will you maintain staff morale in those moments that are challenging?

______

Part IX: STAFF APPLICATION

Do you have a parent, spouse, son, daughter, sister, brother, brother-in-law, son-in law, sister-in-law, daughter-in-law, step-parent and/or grandparent currently employed by the Augusta School District in a supervisor’s position? ______

If yes, please indicate the name of the individual, your relationship to the person and their current supervisor’s position with the district. ______

If you are recommended for employment a criminal background check must be satisfactorily completed before you will be hired. Conviction of a crime or pending charge is not an automatic bar to employment. The district will consider the nature of the offense, the date of the offense and the relationship between the offense and the position for which you are applying.

I certify that the answers given by me in this application are true and correct without omission of any kind. I agree that the district shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in the application. I authorize the school district to make any investigation of my personal or employment history and authorize any former employer, person, firm, corporation or governmental agency to disclose to the school district any information they may have regarding me. In consideration of the school district’s review of this application, I hereby release the district as well as all providers of information from any liability and for any damage that may result from the furnishing and receiving of this information. A copy of this authorization and release is as valid as the original and should be recognized as such.

______

Signature of ApplicantDate

The AugustaSchool District will keep employment applications on file for one year. If a vacancy exists, all applications pertaining to that vacancy will be pulled and considered. After one year, all applications and any materials attached thereto shall be destroyed.

The AugustaSchool District is an equal opportunity employer. The School District of Augustais committed to a policy of nondiscrimination in relation to race, religion, sex or sexual orientation, age, national origin, handicap, marital status, political affiliation, arrest or conviction record, or other factors provided for by state and federal laws.

Part X: BACKGROUND CHECK

If you are recommended for employment a criminal background check must be satisfactorily completed before you will be hired. Conviction of a crime or pending charge is not an automatic bar to employment. The district will consider the nature of the offense, the date of the offense and the relationship between the offense and the position for which you are applying.

Have you ever been convicted of a crime? ______Yes______No

Have you gone by any other name(s) during your employment history?

_____Yes _____No If yes, please list them ______

In order to complete a criminal background check in the State of Wisconsin we need to know your date of birth.

Date of birth ______

______

Signature of ApplicantDate

Return this application and materials to the District Office.

Augusta Area School District

Attn: Ryan C. Nelson

District Administrator

E19320 Bartig Rd

Augusta, WI54722

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The Augusta School District is an equal opportunity employer. The District does not discriminate on the basis of sex, race, color, religion, creed, age, national origin, ancestry, pregnancy, marital status or parental status, sexual orientation, disability or other factors provided for by state and federal laws.

Reasonable Accommodation

Reasonable accommodation, including the provision of informational material in an alternative format, will be provided for qualified individuals with disabilities upon request.

To request accommodation, please contact Audrey Boettcher, (715)286-3301, or Augusta School District E19320 Bartig Rd., Augusta, WI 54722. Email:

1/25/16