CMSD Board of Education Application

Personal Data

Name

Phone

Email

Date of Birth

Spouse's Name

Spouse's Employer

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

How long have you been a resident of the Cleveland Municipal School District?

City of Residence

How many children do you currently have in CMSD?

How many children do you currently have enrolled in non-CMSD schools?

Which schools?

How many of your children have ever attended the CMSD?

Did you attend CMSD schools?

Yes

No

Do you have any relatives (by marriage or by blood) employed by the CMSD?

Yes

No

Relative's Name and Position

Have you, or any family members, ever applied for a position with the CMSD?

Yes

No

If so, what position?

Have you ever been convicted of a crime other than a traffic violation?

Yes

No

What is your gender identity?

What do you consider your race?

What do you consider your ethnicity?

Educational Background

Please list high school and colleges attended and diplomas or degrees earned.

Community Involvement

Please describe your current and prior community and civic involvement.

Employment History and Experience

Current employer

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Telephone

Title or Position

Dates of Employment

Previous Employer

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Please describe your prior experience and expertise in the fields of education, finance, and business management.

Related Experience and Information

Why are you interested in serving as an appointed School Board Member?

What do you believe should be true for students that attend the Cleveland Metropolitan School District? What do you see as the biggest priorities to get the district there?

What do you believe are the most important responsibilities of a school board member?

What are the primary strengths that you would bring to the position of appointed School Board Member?

Please describe the relationship between parents and CMSD that would be most beneficial to students. How can CMSD foster that relationship most effectively? What is your role as a board member in these relationships?

Given the varied racial, ethnic, cultural, and gender identities of young people in CMSD, how can the board foster equitable systems and inclusive culture? How have your professional, civic or volunteer experiences prepared you to contribute to this work?

Please describe your prior experience and expertise in the fields of education, finance, and business management

Describe the relationship you believe the Board should have with the community. How would you ensure that as a board member? What stakeholder groups for the district do you have existing relationships with?

What is your expectation of the time requirements of School Board Membership?

Have you ever served on a Board before? What was the most important thing you learned being a board member and how will that experience support your service to this board should you be selected?

Applicant Authorization and Consent for Release of Information

All applicants who are under consideration for an appointment to the Board of Education of the Cleveland Municipal School District are subject to a criminal records check by the Ohio Bureau of Criminal Identification and Investigation (BCII). Applicants must provide fingerprint impressions on a form specified by the BCII and give the BCII permission to obtain a copy of any arrest or conviction record. If the applicant has not lived in Ohio for five years or is unable to provide proof of residency, the Panel may ask the BCII to perform a nationwide check through the Federal Bureau of Investigation (FBI). The Panel reserves the right to request a nationwide FBI check even if the applicant presents proof of residency for five years.

The Nominating Panel may, in its sole discretion, consider you conditionally pending satisfactory completion of the records check. If the records check is not satisfactory, or reveals that you have been convicted or pled guilty to certain criminal offenses, the Panel will terminate consideration of your application.

I certify that information provided by me in connection with this application is true and accurate. I understand that any misrepresentation or omission of facts is sufficient cause to reject my application and cause my removal from the School Board if selected.

I authorize the Nominating Panel to verify, by references or otherwise, any information provided in this application. I authorize the companies, schools and persons named in my application to provide information regarding me and hereby release them from all liability in connection with the release of this information.

I authorize the Nominating Panel to perform background checks into the records of any law enforcement agencies for records of criminal convictions, into the records of the Bureau of Motor Vehicles or other motor vehicle records, and into any workers’ compensation records. I acknowledge and understand that any adverse information obtained in conducting background checks will be considered in the decision whether or not to nominate and/or appoint me and may be the basis for a decision not to nominate and/or appoint me.

I authorize any individual or entity to reveal to the Nominating Panel, orally and/or in writing, the results of this verification process. I release the Nominating Panel, the Cleveland Municipal School District, the City of Cleveland, the State of Ohio, and any individual or entity providing or receiving information regarding this application from any claims, damages, losses, liabilities, costs and expenses related to gathering and reporting information pursuant to this release and from any other charge or complaint related to obtaining and/or reporting any information pursuant to this
release.

I have read, understand, and agree to the Applicant Authorization and Consent for Release of Information

CMSD Board of Education Application

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