Application Information

Full Name: Date: :
Last First M.I.

Address:
Street Address Apartment/Unit #

City State Zip

Phone: Email:

Present Position/School Corporation:

Years in This Position Years in Corporation

Pupils Enrolled Elementary Schools

Total Certified Staff Intermediate Schools

Total Classified Staff Middle/Jr. High Schools

Annual District Budget Senior High Schools

Do you hold a valid Indiana Superintendent’s License? Yes No

May we contact your current employer? Yes No

Length of Present Contract Expiration Date Date Available

Buy-out Clause Current Salary Board Paid Annuities

Life Insurance Face Value Travel Allowance.

Long-Term Disability Yes No Dental Insurance Yes No

Vision Insurance Yes No Health Insurance Yes No

Other Insurance or Benefits

Professional Experience and Employment Record
(Please list the most recent first)

Position Organization Dates of Employment

Graduate and Undergraduate Experience
(Please list the most recent first)

Institution Dates Attended Major/Minor

Degree/Date

Professional Leadership
Please list three (3) professional organizations in which you have been most active

(List offices held, awards, etc.)

Professional Organization Offices Held Responsibilities

Application for Superintendent Questions

On a separate sheet, respond to each of the following questions/remarks in 300 words or less.

Attach your responses to the application

1. Describe your experience in budget and finance. How will you work to oversee the budget and
provide sound finances for the future?

2. Southmont Schools takes great pride in community involvement. It is vital that the superintendent
be involved in community activities, both district-wide and county-wide. Describe how you will

be involved, communicate, and be a leader in both district and county activities and

organizations.

3. How will you maintain the integrity of Southmont Schools while retaining current students and
attract new students and families to the district?

4. Please describe your direct experiences and outcomes with contract negotiations.

Additional Application Information
Please answer the following questions

(Please list the most recent first)

If you answer YES to any of the first five questions, please explain on a separate page. Include the

date of the incident, the charge, the court action taken, the offense in question, and the address of

the court involved.

1. Are you presently being investigated or under a procedure or process to consider your discharge

for misconduct by your present employer?

Yes No

2. Have you ever been reprimanded, disciplined, discharged, or asked to resign from a position?

Yes No

3. Have you ever resigned from a prior position without being asked but under circumstances

involving your employer’s investigation of your sexual conduct with another person, mishandling

of funds, or other criminal conduct?

Yes No

4. Have you ever pleaded guilty or no contest to or have been convicted of any crime involving

sexual abuse of any person or any crime of moral turpitude?

Yes No

5. Have you ever been convicted of a misdemeanor and/or felony or ever entered a plea of guilty or

a plea of no contest, or has any court deferred further proceedings with entering a finding of

guilty or placed you on probation for a crime?

Yes No

6. Are you eligible to work in the United States of America?

Yes No

Additional Candidate Information

If you are tentatively offered the Superintendent position, the South Montgomery Community School

Corporation will complete an extensive background investigation prior to making the final offer of
employment. If you are tentatively offered the position, you will be required to complete the authorization

for an Indiana and National Background Check and submit the signed document by a date directed by the

South Montgomery School Corporation Board of School Trustees.

South Montgomery Community School Corporation does not discriminate on the basis of the protected
classes of race, color, national origin, sex (including sexual orientation, transgender status, and gender

identity), disability, age, religion, military status, ancestry, or genetic information which are classes

protected by Federal and/or State law (collectively “Protected Classes”) occurring in the Corporation’s

employment opportunities, programs, and/or activities or, if initially occurring off Corporation grounds or

outside the Corporation’s employment opportunities, programs, and activities, affecting the Corporation’s

environment.

Notice, Authorization, and Release

I understand that my application will be on file with the South Montgomery Community School

Corporation for at least three (3) years and that materials accompanying this application become the
property of the South Montgomery Community School Corporation.

I certify that I have made no misrepresentations or falsifications of these statements, answers, or included

documents. I am also aware that should investigations disclose such, my application will be disqualified,

my name removed from all eligible lists, and my future applications will not be accepted. I am also aware

that falsification of this application or any accompanying data, may result in dismissal from any position

at the South Montgomery Community School Corporation.

I authorize any person, agency, partnership, or corporation having any information concerning my

background, educational records, or employment records to release such information. This information is

to be used for possible employment with the South Montgomery Community School Corporation

Furthermore, I agree that I have freely signed this document and have a copy of this Authorization and

Release, whether it be a photocopy or otherwise and it shall have equal standing and import as if were the

original.

Signature Date

Professional Attributes
Professional Qualifications and Selection Criteria:

• Central office experience preferred/superintendent experience desired

• Building-level administration experience required

• Effective skills in communication, multitasking, collaboration, and marketing

• Strong working knowledge of community relations and willingness to be a visible leader

in the community

• Approachable leader with proved ability to motivate highly qualified personnel

• Working knowledge of program evaluation, school finance, school law, collective

bargaining, and human relations

• Possess the highest personal standards, good morals, ethics, honesty and integrity

Submittal Information

Submittal Requirements:

All applicants are expected to provide the following:

Letter of Intent

Resume

Completed and signed application

Response to all application questions

Copy of valid Indiana Superintendent license or evidence of qualification

College/University credentials and transcripts

Three (3) current letters of reference (Two years or less)

Directions for submitting applications and credentials:

Inquiries related to this application should be directed to the University Search Team members.

Contact: Dr. Terry McDaniel; tmcdaniel@indstate.edu or Phone: 812-821-7252

Please complete all application documents including the required signatures. Only complete applications

(including all required applications documents) will be considered. All materials should be emailed to:

Dr. Terry McDaniel at tmcdaniel@indstate.edu

Applications may also be sent by postal mail but must be received prior to the application deadline of

February 11, 2022.

Dr. Terry McDaniel

Department of Educational Leadership

Bayh College of Education

Indiana State University

Terre Haute, IN 47809