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Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Bulian Stephanie J LAST NAME FIRST NAME MIDDLE INITIAL
809 Broadway Ave. HOME ADDRESS
Yankton SD 57078 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
None None (Present title) (Current Position Held Since Which Year)
Employer Employer Address City, State, Zip
$ 0.00 None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution Northern State Univ. 2002-2006 B.S.Ed Elementary Education Aberdeen, SD
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Daycare Teacher Roncalli Primary Aberdeen, SD 2005-2006 School Daycare Provider Care-A-Lot Daycare Yankton, SD 2001-2002
(Please explain any gaps in employment – if any.) The gaps that I have had between employment was because of school. I did not work continually through college.
E. REFERENCES Name of Individual Mrs. Lynn Becker Official Position Elementary Teacher Business Phone None Home Phone (605) 664-0371 Email Address [email protected] Name of Individual Mrs. Janine Mohr Official Position University Supervisor Business Phone None Home Phone (605) 338-1520 Email Address [email protected]
Name of Individual Dr. Gayle Bortnem Official Position Education Professor Business Phone (605) 626-2570 Home Phone (605) 229-1526 Email Address [email protected]
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received.
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
1. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
2. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
3. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
4. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
5. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
6. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO No
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Knutson Cindy L. LAST NAME FIRST NAME MIDDLE INITIAL
45750 Timber Road HOME ADDRESS
Vermillion South Dakota 57069 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Director/teacher 12 years (Present title) (Current Position Held Since Which Year)
Employer Trinity Lutheran Preschool Employer Address 816 East Clark City, State, Zip Vermillion, SD 57069
$ 1264.33 a month None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution USD/Vermillion 1988 Bachelor of Science Elementary Education USD/Vermillion 1993 Early Childhood Endorsement
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Director/teacher Trinity Lutheran Vermillion, SD 1994 to present Preschool Director Mathilda Geppert Vermillion, SD 1993 to 1994 Teacher Mathilda Geppert Vermillion, SD 1989 to 1993
(Please explain any gaps in employment – if any.)
E. REFERENCES Name of Individual Cristi McClelland Official Position Board member Business Phone not available Home Phone 624-9751 Email Address None available Name of Individual Dr. Gera Jacobs Official Position USD professor Business Phone not available Home Phone 624-6250 Email Address not available
Name of Individual Becky Aga Official Position office staff Business Phone 624-3113 Home Phone 624-4276 Email Address none available
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. member of AEYC
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
7. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
8. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
9. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
10. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
11. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
12. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO No
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Brockmueller Karmen L LAST NAME FIRST NAME MIDDLE INITIAL
106 Forestview Drive HOME ADDRESS
Yankton SD 57078-4610 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT paraprofessional 2003 (Present title) (Current Position Held Since Which Year)
Employer Yankton Middle School Employer Address 2000 Mulberry Street City, State, Zip Yankton, SD 57078-1872
15,000 None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution Mount Marty College, 1997-2002 Bachelor of Arts Elementary Yankton Education, Special Education minor
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Education Assistant Children's Care Sioux Falls, SD .5 Hospital and School Daycare provider Hugs and Kisses Irene, SD 1
(Please explain any gaps in employment – if any.)
E. REFERENCES Name of Individual Joan Schild Official Position Special Education teacher for 6th grade Business Phone 605-367-6084 Home Phone 605-665-5535 Email Address [email protected] Name of Individual Cindy Brakke Official Position teacher Business Phone 605-367-6084 Home Phone 605-335-8593 Email Address
Name of Individual Candyce Chrystal, Ph.D Official Position Director MMC Education Department and teacher Business Phone 605-668-1271 Home Phone 605-668-1271 Email Address [email protected]
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. Bachelot degree Elementary Education Special Education minor K-12 Assistant Coach, Middle School/Junior High Coach, K-8 Elementary Coach
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
13. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO Yes
14. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
15. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
16. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
17. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
18. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO Yes
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Anderson Jennifer J LAST NAME FIRST NAME MIDDLE INITIAL
413 Davis HOME ADDRESS
Gayville SD 57031 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Head Start Family Services Specialist April 2003 (Present title) (Current Position Held Since Which Year)
Employer USD Head Start Employer Address 414 E Clark Rm 326 Julian Hall City, State, Zip Vermillion SD 57069
$ 25,000 10 1/2 months of the year None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution USD/Vermillion 1990-1993 BS in ED. Elementary with middle school endorsement in science, social studies, language arts SDSU/Brookings 1988-1990 None Studying in early childhood
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Family Services USD Head Start Vermillion SD September 1, 2000 Specialist
(Please explain any gaps in employment – if any.)
E. REFERENCES Name of Individual Mary Main Official Position Director USD Head Start Business Phone 1-800-813-8132 Home Phone 605-624-2508 Email Address [email protected]
Name of Individual Carmen Stewart Official Position Assistant Director USD Head Start Business Phone 1-800-813-8132 Home Phone 605-624-2103 Email Address [email protected]
Name of Individual Kathy Nelson Official Position Health Coordinator USD Head Start Business Phone 1-800-813-8132 Home Phone 605-6249874 Email Address [email protected]
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. Cuurently a State Head Start Representative on the SDHSA Board
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
19. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
20. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
21. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
22. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
23. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
24. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO Yes
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Anderson Danene M LAST NAME FIRST NAME MIDDLE INITIAL
806 Linn HOME ADDRESS
Yankton SD 57078 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Child Care Provider 2002 (Present title) (Current Position Held Since Which Year)
Employer Kolor Me Kids Employer Address 1501 Locust City, State, Zip Yankton SD 57078
6.60 None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution University of South 2001-2005 Bachelors in Social Social Work Dakota Work
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Child Care Provider Kolor Me Kids Yankton SD 57078 2002-current YWCA Before and YWCA Huron SD 1997-2001 After School Enrichment Porgram
(Please explain any gaps in employment – if any.)
E. REFERENCES Name of Individual Lisa Schroeder BSW Official Position Social Worker Business Phone 605-665-7755 Home Phone Email Address Name of Individual Lynette Erickson Official Position Daycare Owner Business Phone 605-665-7755 Home Phone Email Address
Name of Individual Jeanie Wieger Official Position Teacher Business Phone Home Phone 605-670-6666 Email Address
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. South Dakota Licensed Social Worker
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
25. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
26. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
27. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
28. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
29. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
30. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO No
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
La Croix Amanda Darlene LAST NAME FIRST NAME MIDDLE INITIAL
POB 503 HOME ADDRESS
Yankton SD 57078 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Disability Support Professional 2005 (Present title) (Current Position Held Since Which Year)
Employer Ability Building Services Employer Address 3000 Douglas City, State, Zip Yankton, SD 57078
$ 8.70 an hour None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution The University of 2000-2006 B.S. E.D. ELED ELED/with Early South Dakota Childhood Endorsement
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Kindergarten-Student Yankton School Yankton ,SD 2006 Teaching District (Lincoln Elementary) Third Grade-Student Yankton School Yankton, SD 2006 Teaching District (Lincoln Elementary) USD Daycare- The Unversity of Vermillion, SD 2006 Practicum South Dakota
(Please explain any gaps in employment – if any.)
E. REFERENCES Name of Individual Donna Livingston Official Position Kindergarten Teacher Business Phone Home Phone Email Address DLivingston.ysd.k12.sd.us
Name of Individual Official Position Business Phone Home Phone Email Address
Name of Individual Official Position Business Phone Home Phone Email Address
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. Early Childhood Endorsement Recipient of the 2006 Internet/Technology Award
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
31. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
32. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
33. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
34. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
35. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
36. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO No
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Mullican Mona K LAST NAME FIRST NAME MIDDLE INITIAL
426 E 14th Ave HOME ADDRESS
Mitchell SD 57301 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Computer Lab Supervisor Feb. 2003 (Present title) (Current Position Held Since Which Year)
Employer LB Williams and Longfellow Elementaries, Mitchell Public Schools Employer Address 800 W 10th Ave City, State, Zip Mitchell, SD 57301
$ 8.15 hr None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution Dakota Wesleyan 1990 - 2004 University, Mitchell, SD Idaho State 1981-1983 BA Elementary University, Pocatello, Education, Minors: Id. Early Childhood Ed. and Library Science Rocky Mountain 1979-1981 College, Billings, Mt
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Computer Lab Mitchell Public Mitchell, SD 2003-Present Supervisor, Grades K- Schools 5 Substitute Teacher, Mitchell Public Mitchell, SD 2000 -2003 Preschool - grade 12 Schools 6th Grade Teacher, all Inkom Elementary, Inkom, ID 1985-1988 subjects Marsh Valley School District
(Please explain any gaps in employment – if any.) From 1988 to 2000, I chose to be a stay at home mom to my three children. I returned to substitute teaching when my youngest child entered the first grade. I feel this was in the best interest of my children. While I was at home full time I often took care of my friend children when they were at work.
E. REFERENCES Name of Individual Deb Olson Official Position Principal, LB Williams Elementary Business Phone 605 995 3051 Home Phone Email Address [email protected]
Name of Individual Mary Chartrand Official Position Teacher, Mitchell Middle School Business Phone 605 995 3051 Home Phone Email Address [email protected]
Name of Individual Lori Wagner Official Position Children's Librarian, Mitchell Public Library Business Phone 605 995 8480 Home Phone Email Address
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. Board Member, Mitchell Public Library, Mitchell SD, 1995 -2005
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
37. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
38. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
39. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
40. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
41. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No 42. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO No
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Slowey Sara Ann LAST NAME FIRST NAME MIDDLE INITIAL
101 Summer HOME ADDRESS
Yankton SD 57078 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Secretary 2002 (Present title) (Current Position Held Since Which Year)
Employer Larry's Heating and Cooling Employer Address 920 Broadway City, State, Zip Yankton, SD 57078
$ 9.00 / hr None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Site Coordinator Just For Kids Yankton, SD 1998-2002 Childcare Worker Children's Care Sioux Falls, SD 1995-1997 Hospital and School Infant Room Helper Kiddy Korner Bothell, WA 1991-1992
(Please explain any gaps in employment – if any.) Any gaps of employment that shows experience with children was filled by other positions. I also took time off after having each of my children.
E. REFERENCES Name of Individual Gretchen Slate Official Position DCI Agent Business Phone Home Phone 605-661-0029 Email Address [email protected] Name of Individual Deb Cap Official Position CPA Business Phone Home Phone 605-665-3700 Email Address [email protected]
Name of Individual Cami Ahlers Official Position Vice President Business Phone 605-665-1552x202 Home Phone 605-665-1542 Email Address [email protected]
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received.
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
43. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
44. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
45. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
46. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
47. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
48. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO Yes
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
La Croix Amanda D LAST NAME FIRST NAME MIDDLE INITIAL
POB HOME ADDRESS
Yankton South Dakota 57078 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Disability Support Professional 2005 (Present title) (Current Position Held Since Which Year)
Employer Ability Building Services Employer Address 3000 Douglas City, State, Zip Yankton, SD 57078
$ 8.70 an hour None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution The University of 200-2006 BSELED ELED with Early South Dakota Childhood Endorsement
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Student-Teaching Yankton School Yankton South 2006 Kindergarten DIstrict-Lincoln Dakota Elementary Student-Teaching 3rd Yankton School Yankton South 2006 Grade District-Lincoln Dakota Elementary Practicum Teaching USD Daycare Vermillion South 2005 birth-preschool Dakota
(Please explain any gaps in employment – if any.)
E. REFERENCES Name of Individual Cecilia Fitzsimmons Official Position 3rd Grade Elementary Teacher Business Phone 605-665-7392 Home Phone 605-665-8837 Email Address [email protected]
Name of Individual Donna Livingston Official Position Kindergarten Teacher Business Phone 605-665-7392 Home Phone 605-664-8104 Email Address
Name of Individual Marilyn Jensen Official Position Student-Teacher Field Base Supervisor Business Phone 605-677-5932 Home Phone 605-253-2842 Email Address [email protected]
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. Early Childhood Endorsement 2006 Internet/Technology Award
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
49. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
50. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
51. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
52. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
53. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
54. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO No
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date Application for Employment
Director of Daycare Services
For the Gayville-Volin School District
A. PERSONAL INFORMATION
Stark Christina E. LAST NAME FIRST NAME MIDDLE INITIAL
PO Box 21 HOME ADDRESS
Utica SD 57067 CITY STATE ZIP CODE
B. CURRENT EMPLOYMENT
Kindergarten Teacher 2005/Former 5th Grade Teacher for 2 years (Present title) (Current Position Held Since Which Year)
Employer Santee Community School Employer Address 206 Frazier Ave. E City, State, Zip Niobrara, NE 68760
31,000 None Present Annual Salary Annuity, if any
C. EDUCATIONAL BACKGROUND Please list the colleges or universities you have attended and the degrees received. List them in order, beginning with the most recent. Name/Location of Year (s) Degree Major Institution University of South 2005-Present MA Arts Early Early Childhood Dakota Childhood Education Education Northern State 1999-2002 BsEd Elementary University Education/Minor in Early Childhood
D. DAYCARE AND EDUCATION EXPERIENCE Please list any experience for this position, begin with the most current assignment. Position Employer City and State Year of Employment Tutor Smee School District Wakpala, SD 2002 Tutor Aberdeen Public Aberdeen, SD 2000-2001 Schools Indian Education Program Daycare Provider Aberdeen Child Care Aberdeen, SD 1998
(Please explain any gaps in employment – if any.) 1998-2000 began college 2001-2002 moved cities
E. REFERENCES Name of Individual Ms. Trudy Clark Official Position Principal Business Phone 402-857-2741 Home Phone Email Address [email protected]
Name of Individual Mrs. Leah Hrbek Official Position Kindergarten Teacher Business Phone 402-857-2741 Home Phone 402-857-3740 Email Address [email protected]
Name of Individual Dr. Maurine Richardson Official Position Professor, Division of Curriculum & Instruction Business Phone 605-677-6221 Home Phone Email Address [email protected]
F. HONORS AND DISTINCTIONS – List any degrees, honors, commendations, elective or appointive offices held, or other distinctions received. NSU Reading Coucil President, National Association for the Education of Young Children, President's List Guided Reading Training HIV/AIDS Training, CPR Training Project Wild Training
G. BACKROUND INFORMATION – If you answer “yes” to any of the following questions, please attach a written response describing, in detail, an explanation of the circumstances involved:
55. Have you ever been convicted or a violation of law other than a minor traffic violation? (The term “conviction” includes any conviction, a guilty plea, a plea of nolo contendere or no contest, a suspended sentence, a deferred sentence, a deferred judgment, or a finding of guilty by a jury or judge?)
_____ YES _____NO No
56. Have you ever been terminated or discharged, or resigned at the request of your employer from any job?
_____ YES _____NO No
57. In connection with your professional responsibilities, have you ever been the subject of a complaint or been disciplined by a court or a licensing board of any state?
_____ YES _____NO No
58. Are you currently under investigation, by any regulatory body, for any alleged misconduct or other alleged grounds for discipline?
_____ YES _____NO No
59. Has there been any incident that could negatively affect your ability to be employed in this district?
_____ YES _____NO No
60. Do you know anyone who is currently employed in the Gayville-Volin School District?
_____ YES _____NO No
H. AUTHORIZATION – Please read carefully and then sign your name if you agree to the terms.
I HEREBY CERTIFY THAT THE STATEMENTS MADE BY ME IN THIS APPLICATION AND ALL RELATED INFORMATION WHICH I HAVE PROVDED ARE TURE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I PROVIDE ANY FALSE, INACCURATE, OR INCOMPLETE INFORMATION, I WILL NOT BE ELIGIBLE FOR EMPLOYMENT, OR IF I AM HIRED, I WILL BE SUBJECT TO DISCIPLINARY ACTION OR DISMISSAL REGARDLESS OF THE DATE ON WHICH THE DISTIRCT DISCOVERS THE VIOLATION OF ITS POLICY REGARDING APPLICATION FORM DISHONESTY.
_ON______Signature of Applicant Date