Official SealDepartment of Budget and Management

Supplemental Questionnaire

Last Name
First Name

 Please indicate your American Sign Language skill level.

Polite (able to greet and exchange pleasantries; indicate or understand an emergency).
Literate (understands a conversation and can respond).
Fluent (is your native language or can converse in the language if it was your native language).
Do not speak sign language.

Please check the position for which you would like to be considered:

Early Childhood Education Dept. -- Birth - 5 years
Elementary Department
Middle School
High School
Reading Specialist
Special Needs/Enhanced Services Program
Technology Education (theatre, media, art)

Do you currently hold a Teacher Certification?  If so, from what state?


Yes No

Have you previously obtained Highly Qualified status from a school district?

Yes No

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