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P. O. Box 23120 3820 Nine Mile Road Henrico Virginia 23223-0420 804 652-3600 I have applied for a position in the Henrico County Public School System and would appreciate any information you may offer in regard to the items below. Please complete this form and return to the Department of Human Resources at the above address. I understand that this information will not be provided to me. P. O. Box 23120 3820 Nine Mile Road Henrico Virginia 23223-0420 804 652-3600 I have applied for a position in the Henrico County Public School System and would appreciate any information you may offer in regard to the items below. Please complete this form and return to the Department of Human Resources at the above address. I understand that this information will not be provided to me. Thank you for your response to this request. Name of Applicant First Middle Initial Last Date Position Applied for Signature of Applicant All applicants may be evaluated on the checklist below. Page two of this document may be used for those applicants who have not taught and as an elaboration of the checklist. Clerical and paraprofessional personnel may also be evaluated on page two. Thank you for your cooperation* Please check each of the items below. Superior Above Average Satisfactory Less than Attendance Attitude/Enthusiasm Judgment Punctuality Character Knowledge of Work Quality of Work Communication Skills Response to Supervision Human Relation Skills IF APPLICABLE Classroom Management Instructional Effectiveness Model for Students Evaluation of Student Progress Rapport with Students Preparation and Organization of Learning Activities Parent/Community Relations Is person under contract Indicate exact dates of service yes no Would you reemploy Grades or subjects taught Print Name Signed Title Organization Address Phone Unknown NAME POSITION DATE Signature. Please complete this form and return to the Department of Human Resources at the above address. I understand that this information will not be provided to me. Thank you for your response to this request. Name of Applicant First Middle Initial Last Date Position Applied for Signature of Applicant All applicants may be evaluated on the checklist below. Thank you for your response to this request. Name of Applicant First Middle Initial Last Date Position Applied for Signature of Applicant All applicants may be evaluated on the checklist below. Page two of this document may be used for those applicants who have not taught and as an elaboration of the checklist. Page two of this document may be used for those applicants who have not taught and as an elaboration of the checklist. Clerical and paraprofessional personnel may also be evaluated on page two. Thank you for your cooperation* Please check each of the items below. Clerical and paraprofessional personnel may also be evaluated on page two. Thank you for your cooperation* Please check each of the items below. Superior Above Average Satisfactory Less than Attendance Attitude/Enthusiasm Judgment Punctuality Character Knowledge of Work Quality of Work Communication Skills Response to Supervision Human Relation Skills IF APPLICABLE Classroom Management Instructional Effectiveness Model for Students Evaluation of Student Progress Rapport with Students Preparation and Organization of Learning Activities Parent/Community Relations Is person under contract Indicate exact dates of service yes no Would you reemploy Grades or subjects taught Print Name Signed Title Organization Address Phone Unknown NAME POSITION DATE Signature. .

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