WPC I$<%;uZӞ@ΫKBLu4cr14h_vWBzLV\!ܖwK*TηۤhK󊑸"dVvm4lpDlT|Z$B? P#ø/CZk9 w'l= M|~g..l*VEON'^FMCxE@xe P70H4EY0AgcVuS vRj`jSܲ`XKKFxߩl ZhDE@!¸;U1>:x 0 0` 0> 0H 0 0P 9 0  0U>"" "Bfdaf BFz D/ D++fafa faf3a5fI B+K D3vafafa222Mfa 0#[UN$ %rMx(|Nw4 m^ \  `&Times New Roman'   MARY BELTON0jrickley .   h:Default ParaDefault Paragraph FontXXX`:Footnote RefFootnote Reference($  0  <D .HeaderHeaderXhx (#%D:XX` hp x (#%D<D .FooterFooterXhx (#%D:XX` hp x (#%DP8Page NumberPage Number /  'XX..      .X#XX.XX#XX.X#  _  3X p x (#%X3  XX#LANDERCOUNTYSCHOOLDISTRICTX#X   X +XX#P.O.Box1300625WeaverAvenueBattleMountain,Nevada89820 2 PH:(775)6352886FAX:(775)6355347X#X+(2$ ,~l!XX..      .X#XX.XX#XX.X#     )XX..      .X#XX.XX#XX.X#  _'Xhx (#%X'    XX#Page  1  ڀof  5  ڀ݌ X Ќ' XXhx (#%'  X#X X#XXX#'Xhx (#%X'     X X# _LCSD_ԀEmploymentApplicationS݌  Ќ' XXhx (#%'  X#X X#XXX#'Xhx (#%X'    X#XX X#(2$ ,~l!XX..      .X#XX.XX#XX.X#  \  `&Times New Roman            X  X Table_A d)1dxd'dxdTable_BTable_CTable_DTable_E'Single1 d'dxdTable_FTable_GTable_H (      (      (  X  X Table_I#|x(~l$XX..      .X#XX.XX#XX.X#OKI C5300(PS)0(@ Z6Times New Roman Regular.XpE;:i+00Uk; ,~l!XX..      .X#XX.XX#XX.X#  _        _ _XX3X p x (#%X3&%XX#Q88APPLICATIONFOREMPLOYMENT  N4XX` hp x (#%XX%NApplicant'sFullName_______________________________________________________________________________    ` (Last)   h     (First) p     (MI) x  (MaidenName)    ` Other   Name(s)______________________________________________________________________________________ z  +%&(Pleaseprovideanyadditionalinformationrelativetochangeofname,useofanassumedname,ornickname,necessarytoenableacheckonyour M k  workorschoolrecord.)    &%+PresentMailingAddress______________________________________________________________________________ x   ` (Street)   h     (City) p     (State) x  (Zip) <   ` PermanentMailingAddress___________________________________________________________________________    ` (Street)   h     (City) p     (State) x  (Zip)    ` TelephoneNumbers:   Present:()Permanent:()Work:()____________ j SocialSecurityNumber______________________________________________________________________________ . +%&(Note:Completionofnumberisoptional.Failuretosubmitsocialsecuritynumberonthisformwillnotprohibitemploymentconsideration.Social  Securitynumbermayberequiredonotherformspriortoemployment.)  Mysignaturebelowauthorizestheschooldistricttoconductabackgroundinvestigationandauthorizesreleaseofinformationinconnectionwithmy  applicationforemployment.Thisinvestigationmayincludesuchinformationascriminalorcivilconvictions,drivingrecords,previousemployers  andeducationalinstitutions,personalreferences,professionalreferences,andotherappropriatesources.Iwaivemyrightofaccesstoanysuch ?] information,andwithoutlimitationsherebyreleasetheschooldistrictandthereferencesourcefromanyliabilityinconnectionwithitsreleaseor   use.Thisreleaseincludesthesourcescitedaboveandspecificexamplesasfollows:thelocalSheriff,informationfromtheCentralCriminal  RecordsExchangeofeitherdateonallcriminalconvictionsofcertificationthatnodateoncriminalconvictionsaremaintained,informationfromthe Ca StateDepartmentofSocialServicesChildProtectiveServicesUnitandanyLocalitytowhichtheymayreferforreleaseofinformationpertainingto   anyfindingsofchildabuseorneglectinvestigationsinvolvingme.  Furthermore,IcertifythatIhavemadetrue,correctandcompleteanswersandstatementsonthisapplicationintheknowledgethattheymaybe Ge  relieduponinconsideringmyapplication,andIunderstandthatanyomission,falseansweredstatementmadebymeonthisapplication,orany ! supplementtoitwillbesufficientgroundsforfailuretoemployorformydischargeshouldIbecomeemployedwiththeschooldistrict. " &%+Date򀀀SignatureofApplicant____________________________________________________ $ %&MARKTHEAPPROPRIATEBOXES:   h INDICATEPOSITION(S)DESIREDFORWHICHYOUAREENDORSED !&  X&%[]NewApplication    h []Teacher   p   []Administrator #9( []PreviousApplicationonFile h   []Guidance p     []Supervisor # ) []FormerEmployeeofSchool h   []Library/Media    []Psychologist $* ЀDistrict `     h []Other(Explain)______________ % +  XListgradelevel(s)and/orsubjectarea(s)inorderofpreference: :'X"- _________________________________________________________________________________________________  (+#.  XAreyouaU.S.citizen?    h   Ifnot,areyoueligibletoworkintheU.S.? )$0 Ѐ[]Yes[]No   h   []Yes[]No *%1  X6X p x (#%XXX%6Q*    Q LANDERCOUNTYSCHOOLDISTRICTISANEQUALOPPORTUNITYEMPLOYER -(5 ЇN4XX` hp x (#%XX%NI.EDUCATIONALANDPROFESSIONALTRAINING(ListChronologically.)  * Xddd Xdd Xdd XX%X%,rr, rr,rr,rr,9rr,rr,rr+  :' :dd+%&Levelof 7  0Education 6# 6 0dd 0ӀNameofSchoolorUniversity 6# 6 0dd 0State 6#  6 0dd 0ӀFieldofStudy 6#  6 0dd 0Degree 6# 6 0d 0dYearof 7 Graduatio  n 6#q 6 0ddDatesofAttendance 7  0From.....To&%+ N;#   N 0K(X;Kdd+%&High   0School&%+ 6#- K 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6#  6 0d 0d 6#" 6 0d 0d 6#$ 6 0d 0d N;#&   N 0K(X Kdd+%&Collegeor = [(  0University&%+ 6# ) 6 0d 0d 6#= [+ 6 0d 0d 6#= [- 6 0d 0d 6#= [/ 6 0d 0d 6#= [1 6 0d 0d 6#= [3 6 0d 0d N;#= [5   N 0K(X Kd 0d 6# 7 6 0d 0d 6# 9 6 0d 0d 6# ; 6 0d 0d 6# = 6 0d 0d 6# ? 6 0d 0d 6# A 6 0d 0d N;# C   N 0K(X Kd 0d 6#0 NE 6 0d 0d 6#0 NG 6 0d 0d 6#0 NI 6 0d 0d 6#0 NK 6 0d 0d 6#0 NM 6 0d 0d 6#0 NO 6 0d 0d N;#0 NQ   N 0K(X! Kd 0d 6#g S 6 0d 0d 6#g U 6 0d 0d 6#g W 6 0d 0d 6#g Y 6 0d 0d 6#g [ 6 0d 0d 6#g ] 6 0d 0d3)'g _    3 0K(Xj KII.STUDENTTEACHINGEXPERIENCE(ListChronologicallyandincludeanyinternships.) . a * XdXdrr rr rrrr9rr9rrrrX%X%,rr,rr,Xrr, rr,rr+  :' b  :d 0d+%&NameofSchool 6#Ge d 6 0d 0dSchoolDistrict 6#Ge f 6 0d 0dState 6#Ge h 6 0d 0dӀGradeLevel/Subject 6#Ge j 6 0d 0dDates N;#Ge l   N 0K(XKd 0d 6#Wun 6 0d 0d 6#Wup 6 0d 0d 6#Wur 6 0d 0d 6#Wut 6 0d 0d N;#Wuv   N 0K(X!Kd 0d 6#gx 6 0d 0d 6#gz 6 0d 0d 6#g| 6 0d 0d 6#g~ 6 0d 0d3)'g    3 0K(XCaK&%+III.TEACHINGEXPERIENCE(ListChronologically.DONOTINCLUDESUBSTITUTETEACHING.)  * XdXdrrrrXrrX rr rrX%X%,rr,rr,Xrr,Srr,rr,rr,Xrr,rr+  :' :dd+%& 0SchoolDistrict/School 6# 6 0dd 0Supervisor/Administrator 6# 6 0dd 0State 6# 6 0ddӀPositionHeld  > ЀGrades/SubjectTaught   0Ӏ(Specify) 6#x 6 0ddӀDates  >  0Mo./Day/Yr  . 6#x 6 0dd 0Total  Years 6#x 6 0ddFull  > Time   0Ӏ(X) 6#x 6 0ddPart  > Time   0Ӏ(X) N;#x   N 0K(X$BKd 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d N;#   N 0K(X4R Kd 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d N;#   N 0K(XDb Kd 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d N;#   N 0K(XTr Kd 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d N;#   N 0K(Xd Kd 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d N;#   N 0K(Xt Kd 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d 6# 6 0d 0d3)'    3 0K(X K&%+IV:WORKEXPERIENCEOTHERTHANTEACHING(ListChronologically/attachasheetifneeded.) Z"x * XdXdrrrrXrrXSrrSrrrrXrrXrrX%X%,rr,rr,rr,'rr,rr,rr+  :'-#K-#K :d 0d+%&ԀEmployer 6## 6 0d 0dӀCity/County 6## 6 0d 0dState 6##  6 0d 0dӀKindofWork 6##  6 0d 0dӀDatesof #  Employment&%+ 6#=$[ 6 0d+%&SupervisorNameand # PhoneNumber N;#Y$w   NK(X$ Kdd&%+ 0d 6#M%k  6 0d 0d 6#M%k  6 0d 0d 6#M%k  6 0d 0d 6#M%k  6 0d 0d 6#M%k  6 0d N;#$    NK(X &>!Kdd 0d 6#&! 6 0d 0d 6#&!! 6 0d 0d 6#&!# 6 0d 0d 6#&!% 6 0d 0d 6#&!' 6 0d N;# &>!(   NK(XW'u"Kdd 0d 6#'"* 6 0d 0d 6#'", 6 0d 0d 6#'". 6 0d 0d 6#'"0 6 0d 0d 6#'"2 6 0d3)'W'u"3    3dK(X(#KV:MILITARYEXPERIENCE 4*R%5 * XdXdrrrrrr'rr'rrrrX%X%,rr,z rr,rr, rr+  :'+%&6+%& :d 0d+%&BranchofService 6#k+&8 6 0d 0dӀOccupational+Specialist(MOS) 6#k+&: 6 0d 0dӀInclusiveDates 6#k+&< 6 0d 0dӀTypeofDischarge N;#k+&>   N 0K(X,5'Kd 0d 6#{,'@ 6 0d 0d 6#{,'B 6 0d 0d 6#{,'D 6 0d 0d3)'{,'F    3 0K(XW-u(K&%+6X p x (#%XXX%6Q*  *.H)G    XXXX   VI.CERTIFICATION  N4XX` hp x (#%XX%N+%&A.IfyouhavebeenissuedaNevadacertificate,pleasesubmitaphotocopy........................................................Copyenclosed?No[]Yes[]   XYearofExpirationofNevadaCertificate򀀀 a Provisions______________________________________________  + Endorsement(s)___________________________________________________________________________________________________  _____________________________________________________________________________________________________________________ e   /  XӀHaveyouappliedforaNevadacertificate?[]Yes[]No   When______________________________________________________ i  B.Ifyouhavebeenissuedacertificateinanotherstate,pleasesubmitaphotocopy...........................................Copyenclosed?No[]Yes[]     XState򀀀ExpirationDate򀀀 m   Certificate/Endorsements_______________________________________________________  7  State򀀀ExpirationDate򀀀    Certificate/Endorsements_______________________________________________________ q   XC.HaveyoutakentheNationalTeacher'sExamination?(Ifyes,pleasesubmitacopyofyourscores.) ;   XCoreBattery:No[]Yes[]  򀀀󀀀򀀀򀀀󀀀򀀀󀀀Copyenclosed?No[]Yes[]     XӀMonth/YR  CS  GK p PK u   X SpecialtyArea:No[]Yes[]  򀀀󀀀򀀀󀀀򀀀󀀀Copyenclosed?No[]Yes[] !?    XӀMonth/YR  Subject p Source     &%+VII.GENERALINFORMATION %C Ѐ+%&Month,Day,andYearAvailableforemployment򀀀Areyouundercontract?[]Yes[]No  ЀIfyes,where?򀀀PresentPosition_________________________________________________________  󀀀Ifpresentlyemployed,whydoyouwishtochange?________________________________________________________________________ w ЀIfundercontract,whattype:Annual/Probationary[]Other[]򀀀Continuing/Tenure[] #A 󀀀Ifundercontracthaveyoucheckedandcanyoubereleasedifyouareofferedanotherposition?򀀀󀀀[]Yes[]No  ЀIfnotundercontractnow,haveyoueverheldacontinuingcontractinNevada?......................................................................[]Yes[]No { ЀIfyes,citeschooldistrict(s)anddate(s)_________________________________________________________________________________ 'E ЀReferralSource:Advertisement/Posting[]Employee[]Friend[]Other(Explain)[]_________________________________   Haveyouever:  +I #1Beendismissedfromaposition?    h      p     []Yes[]No   #2Beenaskedtoresignfromaposition?   h      p     []Yes[]No ! #3Beenrefusedcontinuingemployment?   h      p     []Yes[]No /M" #4Beeninvestigatedformisconductrelatedtoyouremployment?     p     []Yes[]No  # #5Hadaprofessionalcertificate,credentialorlicense(ofanykind)revokedorsuspended,or $ haveyoubeenplacedonprobationarystatusforanyallegedmisconductorallegedviolationof 3Q% professionalstandardsorconduct.Arethereanypendingadverseactionsagainstyou? p     []Yes[]No & #6Beendeniedaprofessionallicenseforwhichyouappliedorgrantedaprofessional p      ' licenseonaconditionalorprobationarybasisforanyallegedmisconductorallegedviolation 7 U( Ѐofprofessionalstandardsofconduct?    h      p     []Yes[]No  ) #7Surrenderedaprofessionallicenseofanykindbeforeitsexpiration?   p     []Yes[]No !* #8Beendisciplinedbyanypublicagencyresponsibleforlicensureofanykind,includingbut ;"Y+ notlimitedtoeducationallicensure?    h      p     []Yes[]No ", #9Failedtocompleteacontractforeducationalservicesinanyeducationalorschoolrelatedposition?  []Yes[]No #- #10Beenplacedonleavebyyouremployerorleftsuchemploymentpriortotheendofthecontractterm?  []Yes[]No ?$]. #11Hadacontractnonrenewed,nonextendedorbeendismissedfromemployment?X#X+ p     +XX#[]Yes[]No $ / #12Resignedinlieuofcontractnonrenewal,nonextension,orterminationofemployment?    []Yes[]No % 0 #13Reachedanagreementthatsealsyourpersonnelfileandotherrecords?   p     []Yes[]No C&a!1 #14Receivedanunsatisfactoryevaluation?   h      p     []Yes[]No & "2 #15Doyoucurrentlyhavea LetterofAdmonitioninyourfile?     p     []Yes[]No '"3 Ifyes,pleaseexplainandnotequestionnumberyouarereferencinginyourresponse: G(e#4 * ! dXdrrz rrz rr rr X%X%,#ZZ+  1'($5($ 1$O,m';  $K(X,(K_ S.q)= Ifyouanswer'Yes'toanyofthequestionsbelow,pleaseusetheboxprovidedtogiveadetailedexplanation,includingthedateofthecharge,the  courtaction,andtheaddressofthecourtinvolved.Pleasenotethata"Yes"answertothesequestionsmaynotnecessarilydisqualifyyoufrom  considerationforemployment. :X  Haveyouever:   #1Beenconvicted,pledguilty,orplednolocontenderetoacriminaloffense,otherthanaminortraffic  violation(thisincludes,butisnotlimitedtoafelony,grossmisdemeanor,misdemeanor,_DUI_,etc.)?  []Yes[]No >\ #2Beenarrested(evenifnocontestorchargesdroppedorpleddown)forasexrelatedoffense?    []Yes[]No  #3Beencharged(evenifnocontestorchargesdroppedorpleddown)forasexrelatedoffense?    []Yes[]No   #4Beenconvicted(evenifnocontestorchargesdroppedorpleddown)forasexrelatedoffense?    []Yes[]No B ` #5Beenarrested(evenifnocontestorchargesdroppedorpleddown)foradrugrelatedoffense?    []Yes[]No    #6Beencharged(evenifnocontestorchargesdroppedorpleddown)foradrugrelatedoffense?    []Yes[]No    #7Beenconvicted(evenifnocontestorchargesdroppedorpleddown)foradrugrelatedoffense?    []Yes[]No F d  #8Beenarrestedforanactofviolence,includingdomesticviolence?     p     []Yes[]No    #9Beenchargedwithanactofviolence,includingdomesticviolence?   p     []Yes[]No    #10Beenconvictedofanactofviolence,includingdomesticviolence?   p     []Yes[]No Jh  #11HadareportofchildabuseorsexualactivitiesinvolvingaK12studentorminorfiledagainst   youwithaschooldistrict,astateorfederalagency,apoliceagency,orincourt? p     []Yes[]No   Ifyes,pleaseexplainandnotequestionnumberyouarereferencinginyourresponse: Nl  *]" # dd#ZZ# !X%X%],#ZZ+  1'   1$Vt  $K(X K&%+VIII.REFERENCES  +%&ԀItistheapplicant'sresponsibilitytohavethefollowinginformationprovidedtheSchoolD_istrict_Ԁinordertobeconsideredforemployment:  ̀A.Thenamesofatleastthreereferencesourcesmustbeprovidedandmustincludecurrentemployerifemployed,orlastemployerifnot  Ѐcurrentlyemployed.  ЀB.UnlessincludedinPlacementFile,applicantswithworkexperiencemustproviderecommendationsfromprincipalsand/or 1O superintendentsfromallcontractededucationalworkexperienceswithinthepastthreeyears.Ifexperiencewasnotwithinthepastthreeyears,  providereferencesfromlastcontractedexperience.    XӀApplicantswhoarebeginningteachersregisteredwithacollegeplacementofficemustincludereferencesfromtheirstudentteaching 5S! Ѐsupervisor(s)andcooperatingteacher(s)intheplacementfileorbylistingnamesbelow. "  XӀC.Asindicatedabove,[]aPlacementFileisbeingsent,and/or[]referencesarelistedbelow: # *]$% Xdd#ZZ#" #X%X%],rr,rr,rr,rr+  :'9W$9W :d 0dӀNAMEOFREFERENCE 6#& 6 0d 0dӀPOSITION/RELATIONSHIP 6#( 6 0d 0dӀMAILINGADDRESS 6#* 6 0d 0dӀPHONENUMBER N;#,   N 0K(XIgKd 0d1. 6#. 6 0d 0d 6#0 6 0d 0d 6#2 6 0d 0d N;#4   N 0K(XYwKd 0d2. 6#6 6 0d 0d 6#8 6 0d 0d 6#: 6 0d 0d N;#<   N 0K(Xi Kd 0d3. 6# > 6 0d 0d 6# @ 6 0d 0d 6# B 6 0d 0d3)' D    3 0K(X!K6X p x (#%XXX%6&%+Q &'(N4XX` hp x (#%XX%NIX.EXTRACURRICULARACTIVITIES !D +%&Indicatethenumberofyearsexperienceintheactivitieslistedbelow.Circleactivitiesyouarewillingtocoach/sponsor: |"E *)* XdXdrrrrrrrr$%X%X%,err,err,err,err,rr,rr,rr,err+  :'(#FF(#F :ddӀExtra #H Curricular 8$VI  0Activities 6#$ J 6 0ddHighSchool 8$VM  0Experience 6#$ N 6 0ddCollege 8$VQ  0Experience 6#$ R 6 0ddContracted 8$VU  0Experience 6#$ V 6 0ddExtra #X Curricular 8$VY  0Activities 6#$ Z 6 0ddHigh 8$V] School $ ^  0Experience 6#% _ 6 0ddCollege 8$Vb  0Experience 6#$ c 6 0ddContracted 8$Vf  0Experience N;#$ g   N 0K(X<&Z!Kd 0dFootball 6#&!i 6 0d 0d 6#&!k 6 0d 0d 6#&!m 6 0d 0d 6#&!o 6 0d 0dAct.Director 6#&!q 6 0d 0d 6#&!s 6 0d 0d 6#&!u 6 0d 0d N;#&!w   N 0K(XL'j"Kd 0dBasketball 6#'"y 6 0d 0d 6#'"{ 6 0d 0d 6#'"} 6 0d 0d 6#'" 6 0d 0d_Ath_.Director 6#'" 6 0d 0d 6#'" 6 0d 0d 6#'" 6 0d 0d N;#'"   N 0K(X\(z#Kd 0dBaseball 6#(# 6 0d 0d 6#(# 6 0d 0d 6#(# 6 0d 0d 6#(# 6 0d 0d_Ath_.Trainer 6#(# 6 0d 0d 6#(# 6 0d 0d 6#(# 6 0d 0d N;#(#   N 0K(Xl)$Kd 0dSoftball 6#)$ 6 0d 0d 6#)$ 6 0d 0d 6#)$ 6 0d 0d 6#)$ 6 0d 0dForensics 6#)$ 6 0d 0d 6#)$ 6 0d 0d 6#)$ 6 0d 0d N;#)$   N 0K(X|*%Kd 0dTrack 6#*% 6 0d 0d 6#*% 6 0d 0d 6#*% 6 0d 0d 6#*% 6 0d 0dDebate 6#*% 6 0d 0d 6#*% 6 0d 0d 6#*% 6 0d 0d N;#*%   N 0K(X+& Kd 0dCrossCountry 6#+' 6 0d 0d 6#+' 6 0d 0d 6#+' 6 0d 0d 6#+' 6 0d 0dDrama 6#+' 6 0d 0d 6#+' 6 0d 0d 6#+' 6 0d 0d N;#+'   N 0K(X,'!Kd 0dWrestling 6#-( 6 0d 0d 6#-( 6 0d 0d 6#-( 6 0d 0d 6#-( 6 0d 0dYearbook 6#-( 6 0d 0d 6#-( 6 0d 0d 6#-( 6 0d 0d N;#-(   NK(X-("KddGymnastics 6#@.^) 6 0d 0d 6#..) 6 0d 0d 6#..) 6 0d 0d 6#..) 6 0d 0dNewspaper 6#..) 6 0d 0d 6#..) 6 0d 0d 6#..) 6 0d 0d_ N;#..)   N&'( & 0 '&  (' XXXX (  K(X#Kd 0dFieldHockey 6#Fd 6 0d 0d 6#Fd 6 0d 0d 6#Fd 6 0d 0d 6#Fd 6 0d 0dLiteraryMagazine 6#Fd  6 0d 0d 6#Fd  6 0d 0d 6#Fd 6 0d 0d N;#Fd   N 0K(X$Kd 0dGolf 6#Vt 6 0d 0d 6#Vt 6 0d 0d 6#Vt 6 0d 0d 6#Vt 6 0d 0dStudent Vt Government 6#  6 0d 0d 6#Vt 6 0d 0d 6#Vt 6 0d 0d N;#Vt!   N 0K(X%Kd 0dTennis 6#0# 6 0d 0d 6#0% 6 0d 0d 6#0' 6 0d 0d 6#0) 6 0d 0dHonorSociety 6#0+ 6 0d 0d 6#0- 6 0d 0d 6#0/ 6 0d 0d N;#01   N 0K(X&Kd 0dVolleyball 6#" @3 6 0d 0d 6#" @5 6 0d 0d 6#" @7 6 0d 0d 6#" @9 6 0d 0dClubs 6#" @; 6 0d 0d 6#" @= 6 0d 0d 6#" @? 6 0d 0d N;#" @A   N 0K(X 'Kd 0dSoccer 6#2 PC 6 0d 0d 6#2 PE 6 0d 0d 6#2 PG 6 0d 0d 6#2 PI 6 0d 0dCheerleaders 6#2 PK 6 0d 0d 6#2 PM 6 0d 0d 6#2 PO 6 0d 0d3)'2 PQ   3 0K(X ,(K&%+X.OTHERINFORMATION  R +%&Toavoidconflictofinterest,listanylocalschoolboardmemberoremployeerelative(s)intheschooldistrictandcite  S relationship____________________________________________________________________________________________________________ ` ~T   * U Estimateyourtotalabsencefromworkorschoolforthelastthreeyearsandexplainthereason(s)________________________________________  V ______________________________________________________________________________________________________________________ d W Inyourownhandwriting,provideanyadditionalinformationyoudesirethatwillaffordanadditionalunderstandingofyourqualifications.Your  Y goals,objectives,philosophy,andotherbackgroundfactorsareofspecialinterest. h Z ________________________________________________________________________________________________________________________ 2 [ ________________________________________________________________________________________________________________________  \ ________________________________________________________________________________________________________________________ l] ________________________________________________________________________________________________________________________ 6^ ________________________________________________________________________________________________________________________ _ ________________________________________________________________________________________________________________________ p` ________________________________________________________________________________________________________________________ :a ________________________________________________________________________________________________________________________ b ________________________________________________________________________________________________________________________ tc ________________________________________________________________________________________________________________________  >d ________________________________________________________________________________________________________________________ e ________________________________________________________________________________________________ xf 6X p x (#%XXX%6QADDITIONALREMARKSAND/OREXPLANATIONSFROMSECTIONVIIGENERALINFORMATION h ________________________________________________________________________________________________________________________ |i ________________________________________________________________________________________________________________________ (Fj ________________________________________________________________________________________________________________________ k ________________________________________________________________________________________________________________________ l ______________________________________________________________________________________________________________ ,Jm N4XX` hp x (#%XX%NTheLanderCountySchoolDistrictdoesnotdiscriminateonthebasisofrace,color,nationalorigin,age,religion,politicalaffiliation,disabilities,or o sexinitseducationalprogramsoremployment.Nopersonshallbedeniedemploymentsolelybecauseofanyimpairmentwhichisunrelatedtothe 0 Np abilitytoengageinactivitiesinvolvedinthepositionorprogramforwhichapplicationismade.