Department of Budget and Management

#16-009009-0022
Supplemental Questionnaire

Last Name
First Name

Please indicate your American Sign Language skill level

a. Polite (able to greet and exchange pleasantries; indicate or understand an emergency)

b. Literate (understands a conversation and can respond)

c. Fluent (is your native language or can converse in the language as if it was your native language.)

d. 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?

Yes No

If you answered YES to Question 3, please specify the state in which you hold your teacher certification.

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

Yes No