Osceola School District Intermediate Principal Employment Application

Osceola School District Intermediate Principal
Employment Application
Complete Applications must Include:
1. Employment Application (available at www.osceola.k12.wi.us)
2. Cover Letter
3. Resume
4. Copy of Wisconsin Administrator’s License or proof of eligibility for Wisconsin
5. Copy of Transcripts
6. 3 or more references
7. 3 or more current letters of recommendation
8. Applicant’s name on the top of all pages
9. Responses to Applicant Essay Section (refer to last page of application)
Direct application, materials, and inquiries to:
Mark Luebker
331 Middle School Drive
P.O. Box 128
Osceola, WI 54020
Phone: 715-294-4140
Email: luebkerm@osceola.k12.wi.us
Anticipated Timeline:
April 5, 2012
April 27, 2012
May 1, 2012
May 7-11, 2012
May 23, 2012
Post Employment Opening
Application Deadline
(postmarked no later than April 27, 2012)
Interview Selection
Interviews
Announce New Intermediate Principal
Applications must be submitted or postmarked by April 27, 2012
Osceola School District Intermediate Principal Employment Application Page 1

Osceola School District Intermediate Principal Employment Application
Applicant Information
Last Name First Name Middle Name or Initial Other Name
Street Address Apt # Home Telephone Number
( )
City State Zip Code Day Telephone Number
( )
Email Address
Are you presently under contract with another school district?
If so, what is your present contractual relationship?
Yes
No
License Information
I hold a valid Wisconsin School Administrator’s License issued by the Wisconsin Department of Public Instruction (DPI)
I have conferred with the DPI and believe that I will qualify for a Wisconsin School Administrator’s License should I be selected for
this position. (Enclose a copy of current professional license and any correspondence indicating eligibility for WI Administrator’s License.)
Wisconsin License Number
License Area (Please indicate):
Employment History
Employer Name Start Date End Date
Street Address
Title or Position Held
City State Zip Code Salary
May we contact this employer?
Yes
No
Number of People Supervised (If in supervisory role)
Immediate Supervisor
Phone Number
Reason for Leaving
Osceola School District Intermediate Principal Employment Application Page 2

Employment History
Employer Name Start Date End Date
Street Address
Title or Position Held
City State Zip Code Salary
May we contact this employer?
Yes
No
Number of People Supervised (If in supervisory role)
Immediate Supervisor
Phone Number
Reason for Leaving
Employment History
Employer Name Start Date End Date
Street Address
Title or Position Held
City State Zip Code Salary
May we contact this employer?
Yes
No
Number of People Supervised (If in supervisory role)
Immediate Supervisor
Phone Number
Reason for Leaving
Related Information
Have you ever been disciplined or had your license suspended or revoked by a professional licensing agency?
Yes
No
Have you ever been dismissed or had your contract not renewed by a school district?
Yes
No
Do you have any pending criminal charges against you?
Yes
No
Have you ever been convicted of a crime or pleaded no contest to a criminal charge?
Yes
No
If there are extenuating circumstances regarding any “yes” answer, please state them on a separate sheet of paper.
Evidence of a criminal record does not constitute an automatic bar to employment and any record will be considered only as it may substantially
relate to the position for which you are applying.
Osceola School District Intermediate Principal Employment Application Page 3

Background Check
Full Name (as it appears on driver’s license)
Former Name (if applicable)
Date of Birth Social Security #
Driver’s License #
State Issued
Have you lived in another state other than WI/MN?
Yes No List State(s):
Position Hiring For:
CERTIFICATE OF APPLICANT (Read carefully before signing)
I hereby certify that all statements made in this application are true and I authorize the board to conduct a
background check and investigate all matters contained in this application. I understand that any misstatement
or omission of material fact on this application will cause forfeiture on my part of all rights of employment with
the School District of Osceola. I further agree to complete a medical examination and to furnish such proof of
age and citizenship as may be required.
X _________________________________
Signature of Applicant
____________________
Date
The School District of Osceola does not discriminate on the basis of race, religion, sex or sexual orientation, age, national origin, handicap,
ancestry, color or any other factor provided for by the state and federal laws and regulations. This policy shall prevail in all matters concerning
staff, students, the public, educational programs and services, and individuals with whom the Board does business.
Applicant Essay Section
Please limit response to one sheet of 8 1/2 X 11” paper. Response may be single or double-spaced and no
smaller than a 10-point type font.
Why do you desire to be the leader of the Osceola Intermediate School, and what do you
feel you can contribute to the Osceola School District?
Osceola School District Intermediate Principal Employment Application Page 4