Interim Superintendent Openings Interim Superintendent Application Please fill out the form below. Applicant ProfileName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Do not use a district email address.Degrees Held:InstitutionName of Degree Click the + symbol to add more entries.Honors and DistinctionsMemberships & AffiliationsCommunity ActivitiesLanguages Fluent InMost Recent PositionEmployer* Job Title* Start Date* Are you still employed here?* Yes No Please enter your end date of employement* Location* Total Pupil Enrollment Base Salary* Name of Immediate Supervisor:* First Last Reason for Leaving:*Length of Present Contract:* Date Available:* ApplicationAre you interested in interim Superintendent and/or Superintendent/Principal openings in Arizona?* Yes No Explain your current contract status (e.g. I am in year 2 of a 3-year contract or my contract expires on June 30th of this year)*Should this application be treated as confidential with regard to your present employer?* Yes No Please Comment*Do you have a current Arizona Superintendent Certificate?* Yes No If yes, when does it expire?*Do you have a current Arizona Principal Certificate?* Yes No If yes, when does it expire?*Do you have a Superintendent/Principal Certificate from another state? ?* Yes No If yes, when does it expire?*What is your highest level of completed education?* Bachelor Master Doctorate Other Please explain*In which of these AZ geographies do you have interest?All AZ locationsRuralRural & RemoteSuburbanUrbanAre there any AZ counties you ARE NOT interested in? Yes No If yes, please identify those counties.*Do you have a preference on duration of an Interim assignment? Yes No If yes, please explain.*Do you have a current Arizona fingerprint clearance card? Yes No If yes, when does it expire?*Do you have a minimum salary threshold for an Interim opportunity?* Yes No If yes, what is that amount?*Have you ever been bought out of a contract or put on administrative leave?* Yes No If yes, please explain.*Background Check and InformationHave you ever been convicted of, admitted committing, pleaded no contest, or are you awaiting trial for any crime (excluding only minor traffic violations not involving any allegation of drug or alcohol impairment)? You must answer, "YES" even if the matter was later dismissed, deferred, reversed, vacated or expunged. If you answer "YES" you must provide dates of the proceedings, the name and address of the court where the proceedings occurred, a statement of the accusation against you and the final disposition of the case(s).* YES NO If yes, please explain.*Have you ever been dismissed (fired) from any job, or resigned at the request of your employer, or while charges against you or an investigation of your behavior was pending? You must answer "YES" even if the matter was later resolved with any form of settlement or severance agreement, regardless of its terms. If you answer "YES" you must provide the date of termination of employment, the name, address and telephone number of the employer(s) and a statement of the alleged reasons for termination.* YES NO If yes, please explain.*Have you ever had any license or certificate of any kind (teaching certificate or otherwise) revoked or suspended, or have you in any way been sanctioned by, or is any charge or complaint now pending against you before any licensing, certification or other regulatory agency or body, public or private? If you answer "YES" you must provide the dates of proceedings, name, address and telephone number of the agency or body where proceedings took place, a statement of the accusations against you, the final disposition and/or current status of the charge or complaint.* YES NO If yes, please explain.*Are you now being investigated for any alleged misconduct or other alleged grounds for discipline by any licensing, certification or other regulatory body (teacher certification or otherwise) or by your current or any previous employer? If you answer "YES" you must provide the name, address and telephone number of the employer or licensing body and a statement of the accusations against you.* YES NO If yes, please explain.*When you click the SUBMIT button to apply, two things will occur: A call out will remind you of missing information you need to enter into the form. If a field is missing information. The page will reload with a confirmation message and then you will receive a confirmation email indicating your application has been successfully submitted. If step 2 does not occur, your application has not been officially submitted.
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