Lyons
    Central
    School
    District
    Mission
    Statement
    The
    Lyons
    Central
    School
    District,
    including
    its
    entire
    staff
    and
    community,
    is
    dedicated
    to
    the
    education
    of
    the
    total
    student.
    Together,
    we
    are
    committed
    to
    the
    development
    of
    the
    students'
    academic,
    emotional,
    social
    and
    physical
    well
    being.
    Our
    educational
    system
    supports
    the
    individual
    student
    as
    a
    whole
    person
    and
    affords
    students
    the
    opportunity
    to
    develop
    their
    potential
    to
    become
    productive,
    responsible
    members
    of
    society.
    Application
    of
    Last
    Name
    First
    Name
    Present
    Address
    Street
    City
    Phone
    (
    )
    Permanent
    Address
    Street
    City
    Phone
    (
    Administrative
    Position
    Sought
    I.
    Education
    Administrative
    Application
    for
    Lyons
    Central
    School
    District
    Middle
    Name
    State
    Zip
    State
    Zip
    Availability
    Date
    A.
    College
    or
    University
    Dates
    of Attendance
    Degrees
    or
    Credits
    1.
    2.
    3.
    B.
    Fields
    Hours
    Major
    1. Undergraduate
    2.
    Graduate
    Minor
    Hours
    C.
    All
    Certificates
    Held
    and
    Subjects
    of
    Certification:
    (please
    provide
    copies)
    D
    Certificate
    of
    Qualification
    If you
    do not
    have
    an
    SAS/SDA
    Certificate,
    have
    you
    applied
    for
    one?
    If certified in another state, please describe. ­
    Other licenses held: type and issuing authority
    (please provide copies)
    Expiration
    Date
    D
    Certificate
    of
    Qualification
    Expiration
    Date
    D
    Certificate
    of
    Qualification
    Expiration
    Date
    DYes
    D
    No
    Exp.
    Date
    ­
    School
    Address
    City, State, Zip
    Position held
    Dates
    Number of Years
    Immediate
    Supervisor
    n.
    Experience (DO NOT STATE "See Resume")
    School
    Address
    City, State, Zip
    Position held
    Dates
    Number of Years
    Immediate Supervisor
    School
    Address
    City, State, Zip
    Position held
    Dates
    School
    Address
    City, State, Zip
    Position held
    Dates
    Number of Years
    Number of Years
    III.
    Immediate Supervisor
    Immediate Supervisor
    IV.
    V.
    Personal Data:
    A.
    Social Security Number
    B.
    N.Y.S. Retirement Number
    c.
    From
    what
    secondary
    school
    did
    you
    graduate?
    School
    Address
    City,
    State,
    Zip
    Present
    Salary.
    Year
    Expected Salary
    D.
    E.
    List
    persons
    working
    for
    us
    who
    know
    you.
    Tenure
    Status
    A.
    Were you ever appointed to tenure in a public school district in N.Y.S.
    If yes, complete:
    0
    Yes 0
    No
    Tenure
    Area
    Date
    Tenure
    Granted
    Name
    of
    school
    where
    tenure
    was
    granted
    Address
    B.
    City,
    State,
    Zip
    Were
    you
    ever
    dismissed
    from
    the
    school
    district
    c~nferring
    tenure
    pursuant
    to
    Education
    Law
    section 3020­a?
    0
    Yes
    D
    No
    Other
    Information
    A.
    Have
    you
    ever
    been
    released
    or
    asked
    to resign
    from
    an
    employment
    position?
    Please
    explain:
    B.
    Have
    you
    ever
    been
    convicted
    of
    a crime
    in
    the
    past
    ten
    years,
    excluding
    minor
    traffic
    offenses?
    If
    yes,
    please
    explain
    on
    a separate
    sheet.
    c.
    Are you legally eligible for employment in this country?
    0
    Yes
    0
    No
    (Upon employment you will be asked to produce two original forms of identification.)
    VI.
    Candidate's Statements (Complete Section VI in your own handwriting.)
    (Attach additional sheets if needed).
    A.
    Describe your Philosophy of Leadership.
    B.
    List your accomplishments as an Administrator or as a Teacher.
    C.
    What
    recent
    innovation
    in education
    seems
    to be
    most
    exciting
    and
    promising?
    Why?
    D.
    Briefly
    explain
    your
    supervisory
    experience.
    E.
    Describe
    how
    you
    promote
    parental/community
    involvement?
    F.
    Describe your vision of the areas for which you are applying.
    \0.
    G.
    Is there any other information you may desire to offer which will assist us to properly evaluate your promise as an
    administrator in the Lyons Central School District?
    VII.
    Professional References
    Please include current supervisor, TeacherAssociation President, Community/Board
    Member
    A.
    Current Superivisor
    Address
    City, State, Zip
    Phone Number (
    Position
    B.
    Teacher
    Association
    President
    Address
    City, State, Zip
    Phone Number (
    )
    c.
    Community/Board Member
    Address
    .~
    City,
    State,
    Zip
    Phone
    Number
    (
    VIII.
    My
    placement
    folder
    may
    be
    obtained
    from
    Lyons Central School District is an Equal Opportunity Employer and is in compliance with Title IX, Regulations of the Education,
    Amendment of 1972, which prohibits discrimination on the basis of sex.
    Signature
    Please return to:
    Superintendent of School
    Lyons Central School District
    9 Lawrence Street
    Lyons, New York 14489
    \C.
    Lyons is located in Wayne County, upstate New York, between Rochester and Syracuse.
    The town and
    village have a population of approximately 6,200.
    Over 2/3 of the population
    live in the village of
    Lyons.
    Lyons is the seat of county government.
    Chief occupations are in manufacturing, county
    government and agriculture.
    Lyons
    Central
    School
    District
    is
    a comprehensive
    public
    school
    with
    an
    enrollment
    of
    1,100
    in
    grades
    K­12
    and
    employs
    approximately
    120 professional
    staff.

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