SCHOOL DISTRICT OF HILLSBOROUGH COUNTY TESTING AND CERTIFICATION CENTER 5721 EAST HANNA AVENUE TAMPA, FLORIDA 33610 HONE: 744-8270 Klee 15,1493 Dear DD ua Dare A. Onthe basis of your education, andior training and experience, andlor prior testing, you are being ccertilied for the following position(s) PLEASE NOTE: THIS IS THE ONLY PROOF THAT YOU ARE ON AN ELIGIBLE LIST. YOU HAVE NOT BEEN PROCESSED TO BE USED AS A SUBSTITUTE OR PERMANENT EMPLOYEE, DEES Exceptional Child Attendant applicants must call he Ofice of Related Services, 273-7055, B, Your application does not show that you mee! the established requirements for ____________ tor the following reasonisy: 1.___Education 2 Related Experience 3. Other W you have additional intormation that you feel will substantiate your qualifications, please forward that information to this offic. ce We are unable to process your application, At your earliest convenience, please call us at (813) 744-8270, D. Other comments: ‘School Board policy G-13.1: New employees are stibject to a criminal record check. Ifthe appointee has convictions thal are job related, he/she will be subject to removal. A candidate on probation or parole shall not be eligible for employment.APPLICATION FOR EMPLOYMENT = SCHOOL BOARD OF HILLSBOROUGH COUNTY ao Non-Instructional Personnel ‘ oo School Administrative Center Testing and Certification beiiter He 801 East Kennedy Boulevard 5721 East Hanna Avenue Tampa, Florida 33602 Tampa, Florida 33610 Print in Black Ink or Type. Answer all questions completely and accurately. ropays opars z DATE POSITION(S) APPLIED FOR DATE PosiTion(s) APPLIED FORSS’ “Fe 2 1-23-42. fl dter. Sago & 8 7 ray Trae) — fe " Fy 7 260% = Social Security No. Are you o US. Citizen? Yes Wf No not, what County#_—— joni? Yes _Lae“Fio If you ore employed by the School District of Hillsborough County, you will be required to be fingerprinted. The non-refundable fee will be payable ol the time you ore processed for employment 1 not US, Citizen, are you 9 lawful US. Alien Registration No, Have you ever been convicted or entered o ples of guilly or nalo contendere (no contes!} to @ felony or frst degree misdemeanor? *Yes__. Not yes, whot charges Where convicted = *NOTE: A "yes" answer to this qu ‘elation tothe pasion for which you ore epplyng ore considered Do you have o volid Florida Driver License? ara Flvido Choufewr License? Yes Noy Name Occupational or Professional Licenses or Certificates you possess with state ond date inswed = eeeee Dale) ~ _ ion will not necessarily bor you from employment. The ncture, severity ond.date of the offense in Hove you ever worked for the School a Hillborough County? Yes_ 2 No Ae you crrenily receiving o retirement check? Yes. No fp“ ys, rom whomt _ If yes, whot Department? ‘Ave you 0 Veterant Yes. No_2 wraicams, _ ws __[frowre | Stowmarenn | : ; iyo aa el radvat, do you fave 8 son oO | cen eae Smoot a — " |S, ay Tec lr (2) Ht yes, date isoued: (Mo/year) coe | fc sae Courses completed Teen oa War svg Cote! Som. Hv, Completed University dur Hes, Completed = Degtee AoceNved omer 7 1 a7 1 . — = ueALTH 1. Have you evr resived Workers’ Compensation? Yes a 10 you, your fellow co-worker ‘and employees? It you have answered “Yes" to 1 above, explain - (give dotals, dates, attending physicians, etc). Attach adcitionsl sheet If needed EMPLOYMENT RECORD Begin with present or most recent employment ah 4 sana tuner seamen ot Be BB ce dns or eh. B Job Tie slate Supervisor Descrbe your wort “pelt ce se ste Hong eae — “acted fu eb f ne ne eee Reason tor Leaving phe wt oF LEASES: _ .wet . - 7 Mer vn nine HLL, CO. SC. Brrcl ona non AB MES v0 A nase (AO, Mb st. cryistate te C= sone (feel ESE: wmetatesguosar (05S. ee tine Deceribo your work MaKe. Sune 3 Lhe lea) $ wd sabe. fer Wwe. Kids Machines used in your work Reason for Leaving _ Employer Name = Datos From TO Address. cay/s Job Tile ‘Supervisor Descrite your work Machines used in your work - oaton for Leaving = a mployer Name Dates Fr To bela From —aaarrear ore Address City/State Job Tile \rvmediate Supervisor Describe your work - Machines used in your work Reason for Lea APPLICATION MUST BE SIGNED IN ORDER TO BE EVALUATED Before signing, please check enlre opplication for errors or omissions In executing this form I understond thet any employment considerations by the Schoo! Board of Hillborough County are predicated upon the trthfulness of the statements herein conteined. Material folifiction will constitute grounds for disqualification. | further understand thot this employment epplication is public recard. | authorize the School Board to make all necessary ond appropriate invéstigotions of information contained herein and furlher agree to © physical exomination if required a+ o condition of employment oon al BP. sna Coen Wee ‘Complete upper portion on back.SCHOOL DISTRICT OF HILLSBOROUGH COUNTY TESTING AND CERTIFICATION OFFICE, 5721 EAST HANNA AVENUE ROOM 6 ‘TAMPA, FL 33610 PHONE: (813) 744-8900 om Vj C999 Pe, Bingen Mor DearS. opr ‘A. Onthe basis of your education, and/or training and experience, and/or prior testing, you are being cettified forthe following position(s): M tte Den Wren 9 Moki -S nha Wyte lO PLEASENOTE: THIS LETTER IS PROOF THAT YOU HAVE COMPLETED AN APPLICATION [AND CERTIFIED FOR THE ABOVE POSITION(S). YOU HAVE NOT BEEN PROCESSED TO BE USED AS A SUBSTITUTE OR PERMANENT EMPLOYEE. B. Your application does not show that you meet the established requirements for: forthe following reason(s): 1, ___Bdueation 2, ___Related Experience 3. Other. Ifyou have additional information that you feel will substantiate your qualifications, please forward that information to this office. cl We are unable to process your application. At your earliest convenience, please call us ‘at @13) 744-8900, D. * Other comments ee ‘School Board policy G13.1: New employees are subject toa criminal record check. Ifthe appointes has convictions that are job related, he/she will be subject to removal. A candidate on probation oF parole shall not be eligible for employment.Print of Type in Black Ink Resumes may not be subecituted Answer all questions coupletely and accuratel) \ APPLICATION FOR EMPLOYMENT) ing qace or otfia w my = coms cs sarc wip pe Lace. Coa Tirinn, Eee | P.O. 110 Tampa, Florida 33601 | -# Vet.pts. score 74. & Including —T Long -pee ‘Aw EQUAL hy \ae CEITE exer cation DATE 2 —he D B } yping___(Wat WPM.) Date svorthand pate JOROUGH COUNTY» jccurse HILLS RL ‘SERVICE a JUL 1 6 986 Full, PM a ve 2 Nese AY: Soett a PEO EB i 5 mataing i siren Mires ___ Chelsea eal Fla: bere = nee ae fae a i by Tee saat, oot Tors atreh Data 1s for deveminirg sdsinon age ool7 Prone B36 CAA Phone OY /~Y PY 3 (ge Discrimination 1s prohibited by Law) | eae Mien “ 2 U7: cectedat YE.5 TE not, are you a lawful permanent Us 8, Resident? agiscration No. a 4 seurmanysmices tpcade exeise sateen of dties wer cplomee recor A Dachnge snr Hoare | MEERA SERESE: TOSS Glopee on Florida secon for aonang of veterans predereoe 19 gying Seate- 4 ables is regen! O OUPet caries pargoseas Prot of carves dincllley te neque! f0F vetarane 2 disability preference. 4 pate tateree WMP Date Seperated ‘Type of Discharge © ca sneerented Ss AV permnent Clremporary Flparertine ook. (You may sare ny oat) = [pccartos Elenestary or High Schoo! college ‘Graduate School 3 se wighect iwel complaed 1250 S67 E SONG LFTs Less | 2 Month, Year Attended | " ‘Answer below for each school to © | sehoote fame and atdcess of setmot [tran To aghast Level Coopleced. % [Eteaentary b- [Did you graduate? Yes, “No If not, De tave se” Tame Bay Fach | 1993 Mr GezD Equivalency GAecieicate? Yes Yo | igh Scoot fs gay ited aa , Credits Completed Sen. Hrs. Qtr .Hrs. 1 foottese o ; laser =a of [Baeiteey Be apa a Meee wa se Gree Ghopleecd Gems Re Qu Hen, ccadsace basen Mowe Seales oe sca prakacaT Fs Eee hee cree |; WWecaetonaay ours per week: Yajor Study osiess S sah 3 Fora 1 (05-01-86) “oiplosa or transcript required as proof of Degree.au Menke FEN octal Nae "Last Firs “Tiadie security to. Tee you ret been comcted of any Lov violatlone? 1f 10, List charges, dates, locations, and sentence. You tee aot {iy amor eeaffle violationsy and (2) any offense comittol as'a minor which wus finally adjudicated dn a jwentle court or under a youth offender law. AO Fe yor have a valid Fibvida Drivers License? Yo A Valid Florida Guulfeure Lcenee? {JO Uf sot Florida, do - ‘you have an out of state Drivers/Chauffeurs License? TE yes, give state and type of License Name Occupational or Professional Weenses of Certificates you possess, with state and date issued’ fiave you wer been fired or forced to resigat JOU 20, explain — ave Jou ever worked for a Hillsborough County Goverment Office before? ages Wat DepareaeeT Corsican eee Do you have relatives working for Wilisborowgh county Goverment? O) Teir Nase, relationship at Departaent? A) 03-3 TBLOME wooORD [List All Eaployment starting with your present (or most recent) position, and work backward to earliest fenployment. Also, List periods of unemployment. Military Experience, indicate aajor assigments as separate Jenploynent entries; also inclule military grade for each. Current or most recent exploynent : : Nane of Company [Dates Exployed (Give Month [Start Salary|End Salary|Your Title Jand Year) Fron To [address of Company himber eaployees| Name and Title of Your Supervisor|Percentages_ % you x supervised x z Describe Your Work in Detatl fire. worked per week [7% =e fvachines you used in your work [Reason for Leaving | Prior Employment = 3\X> bates Employed (Give Yonth [Start Sallry|ind Salary] Your Title Jané Year) Fron fo bbe Bibl 1y, 9) 5.31 | costodian Address of Company Nane ani Title of Your Supervisor |Percentages__%, Lerkobinn | iecribe Your Work tn betall irs. worked per woot Naze of Company Bupervised 4), ZD clean of Behind the Widsand KeeP we Scrool Cleani ae Machines you used in your work Zétwn Maccre [psssos for Leaving BOR BCrb lo.rat _ poe Leen nn. Social \Name 4 ise iret wiade Security Ne IEMPLOWENT RECORD (Continued) Nase of Company ates Eaployed (Give Month [Start Salary]nd Salary|Your Title . - aod Year).Fron ._ To |adaress of company Naber of [lene and Title of your Supervisor leaployees - you supervised Describe Your Work in Detail fire. worked per wel » g Machines you used tm your work Reason For Leaving Nene of Company [bates Enployed (Give Woneh [Start Salary|fed Salary] Your Title jand Year) Fron. To [address of Cospahy timber fisme and Title of Your Supervisor [Percentages % Jenployees as you supervised| -# Describe Your Work in Detail firs. worked per week [-# hackines you used in your work fkeasoa for Leaving Tease of Company aces deployed (Give Month [Start Salary|ind Salary|Your Tele jand Year) Fron. To laddress of Company fuser exployees| Nene and Title of Your Supervisor [Percentages _ {you supervised Describe Your Work in Detail worked per week Machines you used in your work fieason for Leaving CAFFLICATUO VST SIGHED IN CROER TO BK HVALIATED Before signing, please check satire iin completed thls applteation teeoaes the property of Hllisborawh Ghuney Civil Service. pplication fore will be considered eo evaluate your elucation ani experience. ypiteation for errors or oxtsttons "oly tnforontton coneaiaad on eh tn executing tts form T uaecatanl that any ceplomnent considerations by the County of Hillsborough are pratcated upon the truthfuisens a ee foebia Contateeds Raterich falsification wil conetieute feounda for Aiaqaliftestion.T further understand that Syone application fn puuite recotd. {authorize Hillsboro Cousty to eakm all necessary and appropriate investigations ee farther agree to physical examination if Fequired ae « condition of eoployome Oy at afency+ pete OA [oI (elesse turn to backos r 2 OC i “EMPLOYMENT ne oy oe SUPPLEMENT Hillsborough Oomey Civil Serle Board . Forder ilo X Teapay Flovida ee _ BEEMVE iB BVI) — — cnctal Security Rater” ga a _—_— . HILLSBOROUGH COUNTY 4 MocKe. BerSne in BiiesaeeeNT » wnat anes — ihe inter nel Z chelsea : Terect/iox Coutrene walling address) Lian b FIA ABOIS a im i -622l isphone nusber wiere T may be reached during regular business hours on the basis of my application already on file in the Civil Service Office, please consider me for employment in the following class(es) which 1s (are) now in recruitnent. Check if ‘Enter position # if OPEN Position (or class) title RECRULTMENT PROMOTION Head cnacdiant Lomax. wo ‘Signature Date 8 Form le (3-85) ‘An Equal Opportunity EmployerSCHOOL DISTRICT OF HILLSBOROUGH COUNTY ‘TESTING AND CERTIFICATION CENTER $721 EAST HANNA AVENUE ‘TAMPA, FLORIDA 33610 PHONE: 622-7185 | es Ln “gine aw) W) es pear OL. 9, ae eee ae iy Yaie applaeatlonraann foe x has been processod. 1. LZ on’ the basis of your education, and/or training and experience, and/or prior testing, you are boing certified for the following position(s): Pup NOTE: THIS IS THE ONLY PROOF THAT YOU ARE ON AW ELIGIBER LIST. YOU WAVE NOT BEEN PROCESSED TO BR USED AS A SUBSYLTUTE OR PERMANENT EMPLOYEE, 2 ERS Exceptional Ghild Attendant applicants must call the \ Office of Related Sorvicos, 272-4527. ! | BL Your application does not show that you meet the established requirements | for 3 for the following reason(s): __ Related Experience 3.___ other, 1.___ Bdueation 1f you have additional information that you feel will substantiate your qualifications, please forward that information to this office. @ We are unable to process your application. At your earliest convenience, please call us at 622-7185. D. Other comments: record check. I£ the appointes has convictions that sre job related, | School Board Policy G-13.1: Rew employees aro subject to a criminal f on probation or parole he/she will be subject to removal. A candidat shall not be eligible for employment.APPLICATION FOR EMPLOYMENT HILLSBOROUGH COUNTY CIVIL SERVI RD P.0.80x 1110 TAMPA, FLORIDA 33601 AN EQUAL OPPORTUNITY EMPLOYBES: ~ f vem nw POOLE 24h) — ve eS Oe (RTE ea “inve YOU EVER BEEN CONVICTED OF ANY LAW VIOLATIONS IF 50, LIST CHARGES. OATES. LOCATIONS, AND SENTENCE. YOU MAY OMIT (12 save Au our oF sTave ontvers/enaurreuns cicewaer AJO) iF ves, cive STATE AND T¥PE OF License ————. HUITARY SERUCE: mcivoe concise srarewent oF OUrIEs UNDER EMPLOYMENT REGONO, ik FoWAQwiNG 1 OPTIONAL a5 6 SEQUEIES DbITION, IF CLAIMING VETERANS CIUABILITY PREFERENCE PROOF OF CURRENT DISABILITY RATING (5 ALSO-REQUIRED. room arn. af a ee om eon aettiawn seg ene csEMPLOYMENT RECORD owes Our so. execain frave vou even wonnes ror witisnonoucn counry aerone YES.wnenr LYSEts wnar opricer— AD YC. 1 YOSinie sane seustionsnr ano Gore Orace, wacake. |{OYMENT (Convinied) oeene on HEPUNUNG AND HESEARCH INFORMATION PLEASE CHECK ONE: (CHECK THE RACE/ETHNIC GROUP WITH WHICH YOU IDENTIFY (ONLY ONE?! > CHECK IF HANDICAPPED: Leal el AND (NON. PACIFIC INDIAN om (NON: AND i ; wspanien te REE wien _ 00 NOT WRITE BELOW THIS LINE — FoR OFF} TTT TT TEER FEEPPE } \ ! t | | | i . ' aa { | Q 2 | | i ! j \ 1) i - \ \ i i | \ L \ i 5 ‘ | | 5 - { { i | ~ a ee i= | c L ——— L. APPLICATION FOR EMPLOYMENT SCHOOL BOARD OF HILLSBOROUGH COUNTY Non-Instructional Personnel ‘School Administrative Conter Testing and Certiication Oshiter 901 East Kennedy Boulevard 5721 East Hanna Avenue Tampa, Florida 33602 Tampa, Florida'93610, |. 7] Print in Black Ink or Type. Answer all questions completely and accurately. ToDar's Topay's DATE POSITION(S) APPLIED FOR DaTE POSITION(S) APPLIED FOR : ss 7-93 -$2- it mga yy Ay fol Mank Repir Supewisor 25-93 Mult 1 iworkee. I {-10-¥/ Costad'al fee Secor ® D-5—4G MOM Te des weekerTL® 3-5-1 Electoican LL * 6-1 ~44 Mu lk Trades wrote (fie Oo wane_—_Maace e600 Tat trait Tair ADDRESS. $40. Pfam St “uit Fla. 23617 4736 er Tp Code eon Social Securily No re you a US Gitizent Yes Xo If not, whot Country {not US. on, ore you © lowful US, Resident? Yor. No Alien Registration No. IF you ore employed by the Schoo! Ditrit of Hiliborough County, you will be required to be fingerprinted. the non-refundable fee will be payeble ol the time you are procesad for employment Have you ever been egnvicted or entered o plea of guily or nolo contendere (no conta!) 0 2 felony or fis! degree mitdemeanor# ia, Hg 9 we hk age Wes conde tes, “NOTE: A "yes" answer to this question will not necessarily bar you Irom employment. The nature, severity and dote of the offense in relation 10 the position for which you are applying are considered, Bis jolie ved Psa Brrr eae ee, = AvalidRaide Challe Unset YagZNo_ CKSS DO Nome Occupotional or Profesional Licenses or Certificates you posiess with slote ond dote issued — Hove you ever wotked forthe Schgal Distal Hillborough Coupnd Yor 2 No if yes whor Department 27/2 toh ” ‘Are:You ekiraialy Tedelvag i walcorit chock# Yes. No.7 pas rem who 2 ‘re you 8 Vetaront Yes__. No Lote of Service Service Diobilty Yes No ‘AN EQUAL OPPORTUNITY EMPLOYER $B 70108 tte 1070)EDUCATION ELEMENTARY, JUNIOR, or HIGH SCHOOL COLLEGE (GRADUATE SCHOOL (Circle Highest Grade Completed) fy es fe) a on 6 te ee ge 10s ara ma meanen TL fen | — _ vane aca soto [oreersece¥ Teno. a0 erent oer pecevto| gen EON jor os pate oa ores High GED Certificate? Ye Ne ‘School eae 7 et 0 GMa bres - | yes. date issued: (Mo/venr usnen Major Susy Poe ra eg ten | Et 7 ~ a ‘Major Study cotegu oo Soney eb Compltad = _ : : uses gates —= cave neattn 1. Have you ever recalved Workers! Compensation? Yes we to you, your fellow co-workers, and employees? it you have answered “Yes" to 1 above, explain ~ (give dotals, dates, attending physicians, ec). Atach additonal sheot I needed EMPLOYMENT RECORD ) ‘Begin with present or most recent employ RESUMES MAY NOT BE SUBSTITUTED gt a sass, Wert cut CE BeaSiveS §— cwisue 29, Zz : 7 Describe your work Machines used in your von file Bilas tetipe Reason tor Leaving (Lent.EMPLOYMENT RECORD (Cos) Employer Nome _,. = Dates From ao) = vers PE Tenor ‘aakiter Address cia ene City/State. — — Job Title - Immediate Supervisor Deseribe your work Machines used in your work Reason for Leaving oe — vata ton ston Al Elen ffct(litve © ~ ‘ems Job Tile lected ¢ Immediate Supervisor Dan dacrbe yourwor Change fh a Clef s ad Ect Machines wed in your work LO PF Al eed Reason for Leaving ro Deserta — tmoloyer Nome LULL LO S04, AED dates tom SUI 7 wl Satis Address Proje cre. cys 21 EL _ ob tile Mehr “fre 5 eee Cc lveer = Deere your work ee on . : pipe : _ Machines used in your work - Reoton for Leaving i Employer Nome Dates rom To Ades Cin/stote = fob Tile inmedite Superior Describe your work _ Machines used in your work Reason for Leaving _EMPLOYMENT RECORD (Con) ofl cod emsoynone Hill. C0, ln Koare] vu ton wT =/1=£5. 9 I= 3-13 or Tionineae Loma Liat vote Mead Cac vant se Flas Lethe Describe your worl 6 Cs a Aine Le2 f. Cc: tt Pes peers are Kensie eboal.. Dhifker, cherrsteatet, Cdget, Lariagane ail ect - Machines used in your work 122 As Reoton for teoving ec e ibe pe ee a ete en ey bows ton 9 =F 1 Addrass Yai ner oie Ciy/State Job Tile % th 7 Immediate Supervvor ath Deserve your work’ Le eft efesenl Laces wal frosect& fer tt yes and went t. Ol 60 tuo eacr Mechines vied in your wo LOOL? Efe Ch G Euro tech ) Reason for Leaving ce CN se 40 GHOLECCS 96% che tind If" ” Sfltvised met Cok For 2¢eacS 4. eet Cots | add oe = [ib Tle Immediate Supervisor | Daseibe your work ‘Machines used in your work Reason for Leoving = APPLICATION MUST BE SIGNED IN ORDER TO BE EVALUATED Before signing, pleore check enlre application for errors or omissions In executing this form | understand tha! ony employment considerations by the School Board of Hillborough Counly ore pres the truthfulness of the statements herein contained. Moterol failication will con sounds for disqualification. | fu tho! this employment application is public record. | euthorize the School Board 1o make all necessary ond eppropria information contained herein and further ag | vow La f= Ges sine Aleta. ULL EE sated upon understond investigations of 10 a physical examination if required as a condition of employment,o Employer Name = wo Sc. Bad — Dates From ae. wFeEs th pasress 4007, Wb “5h. oo niffa A worm. ste va emeca at 2 Gees vesstiepa alt 2, ALKE ake. Sure Pct tne Sloot 15 “Wid $d Se fat Maes OIG ge Machines used in your work a Roason for Leaving wa — enooyer time SLL SCO. Sth. Pracd _9-3-93 i padres SOD. fa a, clyistate Job Tile onsite superior Aacbaid hc Sy __ Deserve rere Aialing ne aS a a oe sdnenines used n your work PeSSute. taasnecs Send bested aad SEG y Cesta Reason for Leaving, . = = a) { Py i a nA TN ll vetocte SRAM Mlctet nalil naoress__Went oud of duisne. Giy/state Fembe Ela. ov Tite Zales feller thypse Lexfenler mmodiaie Superior Ze YOUAS Describe your work 22 trek txt Cap fepfac tar Four Yeas. inns ins OF tne nce and econ Alot tue ioe aera eae oe, houses ancl duis ss het tes teth Lata$_Koe A. —Corntens L Siri over qelec f-patt te Lean Be cee fore Gea Machines used in your work SKIN Sans Seactor et tad! Zeit “ae Oe ay Reason tor Leeving Zhe Corfans( lent ark OF bi sress. REA re 2 APPLICATION MUST BE SIGNED IN ORDER TO BE EVALUATED Before signing, pleare check entire application for errors or omissions In executing this form | understand that any employment considerotions by the School Board of Hillsborough County ore predicated upon the troiMizess of the statement herein coniained. Material falification will consivte grounds for disqualification. | further undesstond thot this employment opplication is publie record. | outhorize the School Board to make all necessary and opproprite investigation of informotion contained herein ond further agree 10 a physical exomination if required 03 a condition of employment pon a AS ~P2.0. sanan Crp Gage Complete upper portion on back.SCHOOL DISTRICT OF HILLSBOROUGH COUNTY TESTING AND CERTIFICATION OFFICE VELASCO STUDENT SERVICES CENTER 1202 EAST PALM AVENUE. ‘TAMPA, FL 33605 PHONE: (813) 273-7542 FAX: (813) 273-7223, Quguat /4, 200! ra, Barger Mere Dear 77 eo : ‘A. Onthe basis of your education, and/or training and experience, andlor prior testing, you are being certified for the following position(s): Pherrtinnnes Rear Meyurten PLEASE NOTE: THIS LETTER IS PROOF THAT YOU HAVE COMPLETED AN APPLICATION ‘AND CERTIFIED FOR THE ABOVE POSITION(S)._ YOU HAVE NOT BEEN PROCESSED TO BE USED AS A SUBSTITUTE OR PERMANENT EMPLOYEE. B. Your application does not show that you meet the established requirements for: for the Following reason(s) 1 Education 2, ___Related Experience 3. __Other_ If you have additional information that you feel will substantiate your qualifications, please forward that information to this office. c |We are unable to process your application. At your earliest convenience, please call us (B15) 273-7542. D. Other comments: ‘Schoo! Board policy G13.1: New employees are subject to a criminal record check. If the appointee has Convictions that are job related, he/she will be subject to removal. A candidate on probation or parole shall not be eligible for employmentPLEASE PRINT: oMesce. _ BenSean' a CRIMINAL RECORD INFORMATION - ALL APPLICANTS PLEASE READ VERY CAREFULLY. ATTENTION: Under provisions in Florida Statutes 943.0585 and 943.059, the entire arrest record is revealed to school districts by the Florida Department of Law Enforcement and the FBI when fingerprints are supplied, including "sealed records" and "expunged records." Therefore, you are required to reveal such information on this application Be aware that falsification of records includes omission of information and constitutes grounds for dismissal. Conviction of a crime will not necessarily be a bar to employment. Factors such ‘as age at the time of the offense, type of offense, remoteness of the offense in time and rehabilitation will be taken into account in determining effect on suitability for employment. Oe ene vere auaden? (DULiE NOY sonic s ninor nef viaion) Is there any criminal charge now pending against you other than a minor traffic Yes 0 No a violation? (DUL is NOT considered a minor traffic violation) ® Are you curently on probation or curently under any imposed requirements for Yes C] No of charges other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) IFYES to any of the above, give details below AND refer to the back of this document for further requirements, ie [tee 1 Chara) reord | reerd seal? _| expunget? ate | Location af Charges) Natareof Chara) Dispsti ify that the answers given by me to the foregoing questions and statements are true and correct without any falsifications, omissions, or misleading statements of any kind whatsoever. I agree that the School District of Hillsborough County shall not be held liable in any respest if am not employed or if my employment is terminated because-of false or misleading statements or answers or omission made by me in this application. 3-3-1 ignature Date cimnsternen 8 (OVER)PLEASE NOTE: The application of any person with a criminal history requires review and approval to determine jpplication will be held in a pending file until eligibility for employment. If you have such a criminal history, yout the review process is complete. For each crim jde of this document, provide a narrative account of the circumstances leading to the charge. (You may attach additional pages.) Include inthis statement, . the level ofthe charge (felony or misdemeano:), . the resolution of the charge, and . the conditions imposed upon you as a result ofthe charge Depending on the nature and outcome of the charges described below, you also may be requested to secure and provide a copy of the arresting agency's report, verification of the court's ruling, and documentation of successful completion cof imposed conditionsame we Meare. BenSamn na, fe sect abe d CRIMINAL RECORD INFORMATION - ALL APPLICANTS PLEASE READ VERY CAREFULLY. ATTENTION: Under provisions in Florida Statutes 943,0585 and 943.059, the entire arrest record is revealed to school districts by the Florida Department of Law Enforcement and the FBI when fingerprints are supplied, including "sealed records" and “expunged records.” Therefore, you are required to reveal such information on this application. Be aware that falsification of records includes omission of information and constitutes grounds for dismissal. Conviction of a crime will not necessarily be a bar to employment, Factors such fas age at the time of the offense, type of offense, remoteness of the offense in time and rehabilitation will be taken into account in determining effect on suitability for employment. ee ere lo tra voladon? (DUIis NOT considered a minr afi violation) wes my ci cge now pening agin you ae tn amie vatic Yer CD No EY violation? (DUI is NOT considered a minor traffic violation.) ® Are you curently on probation or curently under any imposed requirements for Yes C] No ao” charges other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.) IFYES to any of the above, give details below AND refer to the back of this document for further requirements. tie | oe Date | Lectin of Charges) Nature of Charen iponion of Charge) eer | reed sca _| expunged? certify that the answers given by me (o the foregoing questions and statements are true and correct without any falsifications, omissions, or misleading statements of any kind whatsoever. I agree that the School District of Hillsborough County shall not be held liable in any respect if T am not employed or if my employment is terminated because-gf false or misleading statements or answers or omission made by me in this pie _ 3-5 — 7 ignature Date ciniatanaaes (OVER)SCHOOL DISTRICT OF HILLSBOROUGH COUNTY ‘TESTING AND CERTIFICATION OFFICE S721 BAST HANNA AVENUE ROOM 6 TAMPA, FL 33610 PHONE: (813) 744-8900 peas oye ‘Dear_mee. Qreete A. Onfibeae of yor station andor rang ud exer ander rr testing yoo el certified forthe following posit (3): (Malti - fades vonher Gr Electace ao IL oa i PLEASENOTE: THIS LETTER IS PROOF THAT YOU HAVE COMPLETED AN APPLICATION AND CERTIFIED FOR THE ABOVE POSITIONS). YOU HAVE NOI BEEN PROCESSED TO BE USED AS A SUBSTITUTE OR PERMANENT EMPLOYEE. d B. Your application does not show that you meet the established requirements for forthe fottowing reasons: 1, ____Bducation 2. __Related Experience 3, __Other —____ {Ifyou have additional information that you feel will substantiate your qualifications, please forward that information to this offic. C.—____Weaare unable to process your application. At your earliest convenience, please call us ‘at (813) 744-8900. D. Other comments: ‘School Boatd policy G13.1: New employees are subject toa criminal record check. Ifthe appointee has cortvictions that are job related, he/she will be subject to removal. A candidate on probation or parole shall not be eligible for employment. corteSCHOOL DISTRICT OF HILLSBOROUGH COUNTY ‘TESTING AND CERTIFICATION OFFICE HANNA CENTER - ROOM 6 - - 572] EAST HANNA AVENUE, TAMPA, FL 33610 PHONE: (813) 744-8900 fomny 27, 2000 A. Onthe basis of your education, sd/ar training and experience, and/or prior testing, you are being cortitied for the following, position(s): PLEASE NOTE: THIS LETTER IS PROOF THAT YOU HAVE COMPLETED AN APPLICATION ‘AND CERTIFIED FOR THE ABOVE POSITION(S). YOU HAVE NOT BEEN PROCESSED TO BE USED AS A SUBSTITUTE OR PERMANENT EMPLOYEE. B. Your application does not show that you mest the established requirements for {or the following reason(s): L Education 2 Related Experience 3. Other Ifyou have additional information that yon fool will substantiate your qualifications, please forward that information to this office c We are unable to process your application. At your earliest convenience, please call us ‘at @15) 744-8900, D. Other comments: _ School Board policy G13.1; New etmplayees are subject to a criminal record check. Ifthe appointee has ‘convictions that are job related, he/she will be subject to removal. A candidate on probation or parole shall not be eligible for employmentSCHOOL DISTRICT OF HILLSBOROUGH COUNTY TESTING AND CERTIFICATION CENTER 5721 EAST HANNA AVENUE. TAMPA, FLORIDA 33610 PHONE: 744-8270 dom. 10, tPF re Cayenne More per ee ‘A. Onthe basis of your education, and/or training and experience, andior prior testing, you are being cortitiad for the following position(s) ee, PLEASE NOTE; THIS IS THE ONLY PROOF THAT YOU ARE ON AN ELIGIBLE LIST. YOU HAVE NOT BEEN PROCESSED TO BE USED AS A SUBSTITUTE OR PERMANENT EMPLOYEE. DEES Exceptional Child Atendant applicants must call the Ottice of Related Services, 273-7055. 8. Your application does not show thal you meet the established requirements for {or the following reason(s): 1,___ Education 2. Related Experience 3. Other _ 1 you have addtional information that you foo! wil substantiate your quaicatlons, please foward that intonation to tis office, c. We are unable to process your application. At your eariast convenience, please call Us at (615) 744-8270. D. Other comments: ‘Schoo! Board policy G-13.1; New employees aré subject to a criminal record check. If the appointee has Convictions that are job related, he/she will be subject to removal. A candidate on probation or parole shall ‘not be eligible for employment,at APPLICATION FOR EMPLOYMENT cue DEAT SCHOOL BOARD OF HILLSBOROUGH COUNTY SAIN Non-Instructional Personnel i oy ay School Administrative Center Testing and Certification Blitef ns! Blnte 901 East Kennedy Boulevard 8721 East Hanna Avenue Tampa, Florida 33602 Tampa, Florida 33610 Print in Black Ink or Type. Answer all questions completely and accurately. roars Topars ATE OSITION(S) APPLIED FOR DATE ‘POSITION(S} APPLIED FOR Ae ee — Lal Mea Subryof % D-B=4 lo Ht TV cadens week a 35 = Cie Tee Spe PERSONAL fon ese eran To ah ay pooress YVO/ Safer s+ - Latha Fla. Fl 7 {A736 Social Security No. ‘ov US, Ciizont Yer W No ino, what County? If not US. Citizen, are you o lawful U.S. Resident? Yes. No __. Alien Registration No. — ne IF you ore employed by the School District of Hillborough County, you will be required to be fingerprinted. The non-refundoble fee will be payable ot the time you are processed for employment Hove you ever been convicled or entered @ pleo of guilly oF nolo contendere (ne conte!) to a Felony or ‘1 Where convicted Dote _ rity and date of the offense in 1 degree misdemeanor? "Yer Noyes, what charges? - *NOTE: Ayes" answer fo this quetion will not necessarily bor you rom employment. The nature, Aron cite oslo fe whch you ore opehoy et could Do you hve 0 vld Farida Driver License? Ye aan Avald Forde Chollour tienit Yo Lo CASS. D Nome Occupotionsl or Professional Licenses or Cerifcates you possess wih state and date issued Have you ever worked for the School Disticlof Hillsborough Céunty# Yes 4 No Tyata droment Head Lebjpggaey ‘Are you currently receiving © relrement chack® Yes No_ga“f yes, from hom a ‘Ave you o Veteran? Yes No_Date af Sevice_____ Service Dinailty Yor. No AN EQUAL OPPORTUNITY EMPLOYER 8B 70108 YormayEDUCATION ELEMENTARY, JUNIOR, or HIGH SCHOOL COLLEGE GRADUATE SCHOOL ee ee eee ee ae vou) 7 2 oY ceed WAME & LOCATION ‘ATTENDED [DEGREE RECEIVED GnEEA bao School JF y 7 a GW a. tf Z eige 1 yes, date fesued: (Movyear). a ~ 7 ~ = Major Study HEALTH 4. Have you ever received Workers’ Compensation? Yes woe, 2, Can you perform the duties of the Job for which you have applied in a manner which Is sate yes yZ —No. {o you, your fallow co-workers, and employees? It you have answered "Yes" to 1 above, explain - (give detals, d tending physicians, ete.). Attach additional sheet f needed. EMPLOYMENT RECORD Begin with present or most rocent employment ’ RESUMES MAY NOT BE SUBSTITUTED ae eee ACA eee RR ee 2 Tada _le/a nasess, Wet cut CC Beane S — cryiswe “La soo tiie ecalee Immpdiate Suverisor_Z77C. Youn S aoe ah a und. sare * at ie a“ Machines used in your work Reason for Leaving onto Cossa EMPLOYMENT RECORD (cont'd) ‘ Cee enoloyer none Hil. CO, Scr Goacd ot tom TELL 85. tod = 3 {3 seen Le fe, ton Leta Flag Job Tile l Cust inmetiore supenisr Flare Gen thers, Deseibe your work —Z jo Away ee led trove Saks aad Lola. Cleoaghs nee fakes) ‘Machines used in your work ite Chergstrad heey cL a re feotos fr Laaving faite 7 a ce 7 (i € tmtprsone He tL co. See. BO. oom tom 9 811, WEhe zen Job Til Immediate Supervisor Deteribe your work Le —_fe haber ane sett fo school » . re etintd US wed 2OO7® chee & Euro tech ) Reason lor Leoving _Scperised! / do 2 Usitkecs _ ployer Nome ats From te Gls ° Monih/Yeor ‘Monih/Yeor Address . Giy/Stare Job Til Immediate Supervisor - Describe your work Machines used in your work — Reaton for Leeving APPLICATION MUST BE SIGNED IN ORDER TO BE EVALUATED Belore signing, please check enlire application for errors or omissions In executing this form | understand that any employment considerations by the School Board of Hillsborough Counly are predicated upon the truthfulness of the statements herein contained. Material falification will consitvle grounds for disqueliication. | further understand thot this employment pplication is public record, | authorize the School Board to moke oll necessary and appropriate invéstigations of information contained herein and further agree to © physical exominclion if required ax @ condition of employment cue _L-L= % sera Aleit GLB _Adaross GAOT. 5 Mesh ciystate Ziad Le. a _ immediate superisor aS S.C Greate MaKe. Se Louk tis Gl ale fot phe Is Job Title, Describe your work Machines used in your work — _ Reason for Leaving _— . - . emptor same Hi] L COs SCh.Pracd ___ bates rom _2;3-€3 to Peager pavross S0O2 Lord. 2. otyotte Zama FL The te immediate Supervisor Aichatd eri sb Describe your work AG Sch Job Tite Machines used in your work “Presse teasers Sen db latbet aad SLA y fer ala Dec. emobyer same MMR Mein, oun ron 1087,» 144, Address Went aud of buisness onsite _Zambe Fg = sob tiie Thales eller tty'tls Cocfemlerinimodiste Superisor Zac YOUAG_— Doser your work ZL taertK tart Copferplec fac Faac Yeas and I did_ala t___ _ Of tre tute and lean alo + tue ,lerenk around to clietcent udare— “houses and bainass doing (ebars, (wher 10103 tserking forte | —Compens/ striker aver arlec 1 part_te. Learn Something, € (Sie egdes Raigtep Machines used myour work SKA aus Sandler Leaueraad ect, (leh tea ) ! Rosson tor Leaving Zhe CorPany tient ot of bisras: mekienes meee APPLICATION MUST BE SIGNED IN ORDER TO BE EVALUATED Belore signing, please check enlire opplcation for errors or omisions in executing this form | understond that ony employment considerations by the School Boord of Hillbarough County ore predicoted upon the truthfulness ofthe slolements herein contoined. Material foliation will consiute grounds for disqualification. | further understond thot this employment opplication i public record. | authorize the School Board te moke ail necessory end appropriate ivéstigations of informotion contoined herein ond further ogree to 0 physizal examination if required as a condition of employment won 23-02, sepa Lop GOL Complete upper portion on back.APPLICATION FOR EMPLOYMENT. a SCHOOL BOARD OF HILLSBOROUGH COUNTY ‘ Non-Instructional Personnel ‘School Administrative Center Testing and Certification Geis d 901 East Kennedy Boulevard 8721 East Hanna Avenue ~\ Tampa, Florida 39602 ‘Tampa, Florida 39610 \v Print in Black Ink oF Type. Answer all questions completely and accurately aa ——roon DATE Posmons) sPPuED FoR ple osetas LL Wea qae (= Bae — Hl ets bs Ae OE = ie, Soecybj _ — Soe Ge ee lt Teade ee sg So _ 3-5 -U¢ Electrica iL" d = 7 6-1-4944 Mo |S Trades Work. Goffe ye [=84_ Moth Trades broker OS aint hale Lewis PERSONAL Moote.. Perso NAME (ian) ee “First RAOUEN (middle) ~~ nooness_ V0 / Per S- _ Tutla _*‘Fla. 33607 a7 SecialSeevty Ne you 0 US. Ciizent Yer ¥f No tf not, what County? re, Cheon ore yu e fowl US, eden Yor_ac No Alto Rgitn Na aes Ifyou are employed by the School Distet of Hilsborough County, you will be required to be fingerprinted. The non-refundobl payable at the time you are processed for employment Hove you ever been epovicted or entered a plea of gully or nolo contendere (no conten) to a felony or fst degree misdemeanor? *Yes___ No_,ZIf yes, what charges? = ~ _ — Where convicted Dole _ vne a” enaver to this quesion win necenoriy bor you fom employment. The nae every ond dee ofthe offense in EE eee bcton fo whch you ore opp are conde toe va __- Avalid Hovida Chavfeue Liceset Yor LNo_ CSSD Nome Occupetionel or Professional Licenses or Cerificotes you posses: with state ond dote issued Hove you ever worked forthe School Distro Hillborough Couny# IF yes, whot Department? 2G 1. — — ‘are you currently ceiving @ retcement cheek? Yes No-{pe“l yes from whom® svn you a Veron? Yes No222 Bate of Senice — aoe Service Disability Yes No [AN EQUAL OPPORTUNITY EMPLOYER 8B 70108 er 10/0)EDUCATION ELEMENTARY, JUNIOR, oF couece rapuare sewoou (Gitcte Highest Grade Completed) raaese7 eo w why) res 4 12 3 4 vxres~ | crapuxreD-o neor peer] soe [ccs nse rua : aes HoWTo | MONTWYEAR i’ you aid ot oradvato, do you have a ah @ p [Ran een we lee, ; P| seo certenio? vor no, 1 BIC a ay Lex. (A, WL. I yes, dat lssuec (Mo/year) Business! Major Study Stel. Tracer Courses completed Tech. Lewin Major Sty coteger Sem. Hrs. Completed at. irs, Completed ee Degree Received 1 ower | HEALTH 1. Have you ever recelved Workers! Compensntion? Yes 2, Can you pertorm the duis ofthe Jb for which you nave appled in a manner whichis wate very We. 0 you, your follow co-workers, and employees? It you have answered "Yes" to 1 above, explain - (give detals, dates, attending physicians, etc). Attach additional shoot it neaded. EMPLOYMENT RECORD \ Begin with present or most recent employment RESUMES MAY NOF BE SUBSTITUTED at @e enoioer vane (Mp JQ Wauurt dere. ke crys Job Tite 2 Immpdiate Supsrisor_Z277C, YOUR G. easing. ane how25eS 4 AW. Describe your work ne aah, fli 18 used in your work Reason for Leaving”nt . Maren empyer vame HHL, G2, Sta Bard —— oa vom EM wi fe PE Cpe ae ee ea —_ tote @ests vane Sperar las S.C. Geeteers ——ee——™— Cacia Mea $ al Sabo fot ue. poe Machines used in your work Reason for Leaving —_— = - = iw ae ee jy fe" — Ohad y OO ESE pesross S02 Lois. o+, - ciyistae “Zemfe Fh —_ sop Tite Paypetec TE neste supervisor Aicratd “Paci Sy deserve your wore __ Cana als) ee 2 Machines used in your work PressaCe. taasnec, Stal cad SHAY Batr - Reason fr Leaving _ = He RE Dec, enporer sane MMR Meitrah, aes rom 18 8 — 0 14 — Addess Went aud of duinast —ewyisine__Zamable_F op tive Zlades frelL@c thyitle Coxpeckes nmediae Suponisor Efi’ Yacsa 9 ——______— Describe your'work 2 CuearK eth Capes uc Years and 1 did alt Cdne tend and lesa dle + tue-terent_acaund to_cl.e€rea\ usice. houses. dad) dutta ss dang (2lairs.Ltather 105 tserlip§ oe tie —Conntens, / Setll aver qelec t peas te Lean Sorébning. & (Se begdes. sy in : focus a4 Machines used in your work SKN Saur Sandler teaset aad ect, | eihails “site ara ine et tere reason for Leaving The Cartfant{ ttead ark OF biSre - ~ APPLICATION MUST BE SIGNED IN ORDER TO BE EVALUATED Before signing, pleose check enfre application for errors or omissions In executing ths form | understand that any employment considerations by the School Board of Hillborough County ore predicoted upon the trothfelness of the statements herein contained. Material faification will consltute grounds for disqualification. | further understand thet this employment opplication is public record. | authorize the School Board to moke all necessory ond approprite invéstigations of information contained herein ond further ogree to © physical examination if required as 2 condition of employment ny ie sna Copnlul Gage a Complete upper portion on back.__ EQUAL EMPLOYMENT OPPORTUNITY REPORTING AND RESEARCH INFORMATION The Kollowing informotion is requested solely in connection with the Affirmative Action objectives of the School Board of Hillsborough County This information is requested on a voluntary bass and wil be kep! confidential to the extent provided by low. Refusal to provide this infor ration will net subject the epplicant or employee to any edverse action Pleate Check One Check The Roce/Ethnie Group With Which You Identity (Only One) oo x oO Be o a o force fod Ae eo ne = ee on ee fet rt nei DO NOT WRITE BELOW THIS LINE — FOR OFFICE USE ONLY Posmion, tev | pare| enous | oare| animm| bare] 1p. |_ DATE] TYPING | DATE | svortnano eidber ZL. — | 42-62 g fon \ter = Trades | yrs 5.43 2 Le dl i10.2.| J-t0| + pled fed ce] 4 tlechive ae To yyy | a-429 ed wed cen fe Stig iti = Zeadeswoates, ose [as be Ae pdms « [sacl os bes Wacker 9 Wood ott 9, eli fewle: el-?, yaytle-rtj7 Ax célenle + 702|1-27}-2 000] E/|x ale nbeunde ~ |f-29-20a04) -29-2000 W03|siflo; ID tim a 8-3/0) [pe 7-0EMPLOYMENT RECORD (Cont'd) a 9 Guch ens vom Hill. CD Spa TBearch___ vou ton nf 285.0 O23 AS | ‘Moni Fear Tniieor sdiren Lontad EL cin/sm Lat f oo immediate Supervisor F/0si.2 Ceapthe rs, Describe your wore Z— be Ghat a postiecs pulse ctee Coal tebe est peepee Biffec, chaste, sel, Lansiesl ail act Reaton for Leaving SAYIO G8" enyrvone Hi LL te. Sco. BO. Dates From fe) te eeetsenk pene Sy ae ciy/stte seb rie Masih TY IF A. inti soir Describe your work. 4 [ fraSectS or +f d A Mochnes wed in your wok L002? Efe Che. Ca Er uv tech faoson for Leaving _ Seppe er'eeq wockec. 96h cheb SOC & paitsed Trt ae So DearS a phenkag 7he i is | Employer Nome Dates om To Address = - Ciy/Store — —— Job Title Superior Describe your work eet Machines used in your work Reason for Leaving APPLICATION MUST BE SIGNED IN ORDER TO BE EVALUATED Before signing, please check entire opplication for errors or omissions ln executing this form | understand that any employment considerations by the School Board of Hillsborough County are predicated upon the uthfulness of the statements herein contained. Material falification will constitute grounds for disquolifcation. | further understand that this employment application is public record, | authorize the School Board to moke all necessary and appropriate investigations of information contained herein and further agree to @ physical examination if required as a condition of employmentEMPLOYMENT RECORD (Cont'd) Employer Nome : se Dates From = To a Address a ct City/State Job Tile — Immediate Supervisor _ Describe your work Machines used in your work Reason for Leaving Employer Nome Job Title a "e a span ee ate Fam IEG” To SL-B-Il sien Ail Fle. (licking =~ nisin Leuba Fl Ele che! c¢ Immediate Supervisor 6 tl Wig Chew B, RLebifacleB Describe your work 2, Machines uted in your work EC LOR Wend Reason for Leaving tnpyer ome LLL £0 SCL. AD oom ton elt vo hese Address Sac ‘| ro} — cinysiae LG _ FL se tte Mesphy * Zpade. immediate Supervior_ Clay Wee _— Describe your work Le paepeet ro ¢ pecwsrp typ epee 7 — Mochines ved in your work Reoron for Leoving _ Employer Name Dates From — To Ciy/Stote - Describe your work _ Immediate Supervisor Machines used in your work Reason for LeavingHILLSBOROUGH COUNTY PUBLIC SCHOOLS HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM a ities ADMINISTRATOR EVALUATION - Professional Development -Track2 (e/a fi 17 cane : ue {[ Name: Moore,Benjamin (121670) “School Year: 2016-2017 | Division: D-FAC Position Tie: Dept Mgr, FaciliesMaintSuprt | Work Location: 9811 Maintenance + = Exoueds Expected Standards = Moots Expected Standards Us Uneatisfecrny® = Not Appabia Enter Bote: — At f 9 Detar 1 FORMATIVE SUMMATNE ——-SUMMATIVE ea erat Sat ator | (January isan yey eyiiey) ‘A. Professional Attfbutes Sha _# oe | B.- Leadership Skis st SF a . Organizations! Skills tr St sr Sst | D. Communication Sis Si eee E. Human Resources Management c+ st i567 € , F, Program/Cunicuium Management S St Ot St 6. Business Management St St St st Coane sit sf sf Ts? ‘SPECIFIC GOALS: (Required; dentty In September.) “eK | 3 0 THLE 76 (35 THE MEK+ CW) Fon, Wl. pep WokkéR th Gees Summative Commons BEW Conti 4 T6 Chow As h Rofessionn 1 an“=" ret magus the smstoorto eb and tar &pfesional porto every paromence. Feedback om mall sures 8 aque component 2 Ani mtg rage re euro prov wise commer above. A°D" meng raits m media pacemen Compeloncy Arsene Tack 3. Selcdnt ev. 0707) Ss . DISTRIBUTOR ORIG: Human Resouces PROTOCOPIES: Aso, vator= ASSESSMENT CRITERIA A. PROFESSIONAL ATTRIBUTES: “Updates sklis and knowladge in specialized feld 2. Displays ethical characterises 3 Demonstrates professional attudes 4, Sets goals that encourage seltiothers to higher standards LEADERSHIP SKILLS Interaction to ft the situation 2, Promotes a positive image ofthe school and district 3, Produces positive resuts in the overall program. Domonstrates decisiveness 5. Uses persuasiveness to Influence others Demonstrates group process and fecitting skit Inklates actions to lead others to improve circumstances. ‘Demonstrates organizational sensitivity Acts within the shared vision, mission and values ©. ORGANIZATIONAL SKILLS 1, Delegates authority and responsibilty appropriately : 2) Follows up on delegated activites 3. Schedules activites and the use of resources for accomplishing goals ‘4, Establishes prooesses to recelve and provide feadback 5. Dasigns, plans, and organizes actives to achieve goels D, COMMUNICATION SKILLS. “7, Writes cleary, concisely, comectly °2 Faciitates communication a all levels ofthe organization 3, Presents Information and Ideas In an open, Informative manner 44, Responds empatheticaly toothers perspectives/ideas =. , HUMAN RESOURCES MANAGEMENT. 4, Establishes high expectations for performance 2. Unilzes district procedures for selection of human resources, 3, Takes postive stops to upgrada staff parformance 44, Assigns staff appropristoly 5.- Evaluates staff according to disvict procedures F. PROGRAM/CURRICULUM MANAGEMENT Identes program needs ‘Davelops goals and objectives ‘Davolopsfimplements district programs Uses physical resources effectivly and efficiently Monitors and evaluates program effectiveness ‘Apples evaluation findings to program management @. BUSINESS MANAGEMENT 1, Uses approved accounting methods 2, Completes reports accurately end on tme 3, Expends funds appropriately and responsibly H, COGNITIVE SKILLS: 1. Gathers and analyzes data from mutiple sourcos 2, Uses pattems and relationships to form hypotheses 23 Uses altemative or multiple perspectives in problem solving ron EE eee “Date ‘Admnin signature jluator’s Signature ‘Summative e ‘Data fistatore Signansrs Evaluators Signauire Placement Recommendation: 1G Professional Development 1 Competency Assistanca 1 Other/Atach memorandum ‘Sho antar en overall assesemartofS,*°N," “Un the Lawson Performance Review Seren ‘35 60001 (Rev. 07107) DISTRIBUTION: ORIGINAL: Human Resources PHOTOCOPIES: Administrator, Evaluatori) HILLSBOROUGH COUNTY PUBLIC SCHOOLS =" HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM Hillsborough Councy ADMINISTRATOR EVALUATION - COMPETENCY DEVELOPMENT unk tlse Benjamin Moore [Psion Tite: Gest Sine Dhh ota | Work Lact: 2 { Mark One: X New Leader (Track 1 first year in postion) —_ Competency Assisiance (Track 3) ‘$+ = Exceeds expected standartis S= Meets expected standards ~ N= Needs improvement (Not appropriate for Track 3 Summative) U-= Unsatisfactory NA =Not applicable in this position OR Not applicable at this time (New Leaders Only) Viel mc 2 | no Enter Date: PROFESSIONAL ATTRIBUTES QO vos ss and krone socal ti 7. bielay ethical characters 4. Demonsrtes professional ates, 4. Sete goat that encourage seloters o higher standards LEADERSHIP SKILLS ‘Adops behavior and interaction to tthe station, Promeles a postive mage ofthe schol and dtc Produces postive results nthe overal rogram Demonsates decisiveness Uses persuaslenessointuence oer. Demoristrates group process and facilitating skill. Initiates acons to led oer o improve creumstances. Demonstrates organizational servi... 6. Aets wth he shared vision, mision and vives : ORGANIZATIONAL SILLS : 1 Deeps ater andasciiy appropriately 2. Follows upon delegate aces : 4, Schedules bes ond he use of esources for eccompishing goa. @Destabishes processes to recive and provide feedback Designs plans, and oganizes acts to achieve gole CONMUNIGATION SKILLS Owes cy es cc Faittates communication ata ovels of te organization 3, Presents information and ideas in an open, informative manner. 4, Responds empathetically to others perspectivestideas... HUMAN RESOURCES MANAGEMENT Establishes high expectations for performance. Uriizes distriet procedures for selection of human resources Takes positive steps to upgrade staff performance. ‘Assigns staff appropriatoly. Evaluates stat according to sstict procedures.Be erconncunmcuim waincrtent — (Uses approved accounting methods. 2. Completes reports accurately and on time... 3. Expends funds appropriately and responsibly COGNITIVE SKILLS 1. Gathers and analyzos data from multiple sources . 2. Uses patterns and relationships to form hypotheses. 3. Uses altemative or multiple perspectives in problem solving Formaive 1 (ohxtberae BG c — Date ‘Rafinssrators Signature Formative 2 7 m Dale ‘Raministraiors Signature Formative 3 C ~~ = Bj ‘Raministaiors Signature ‘Summative y - ate ‘Aaminstrators Signature Placement Recommendation: Professional Development 15 Competency Assistance < ‘Administrators Summative Comments: ‘Ste 10 enter an overal assessment of’8,"7N" or °U"In the Lawson Performance Review Screen ‘53 60802 (Rev. 07/07) DISTRIBUTION: ORIGINAL: Human Resources BHOTOCOPIES: Admivstrator, EvaluatorSAT HILLSBOROUGH COUNTY PUBLIC SCHOOLS _. (ahs fi HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM = 75 1\ —xltshorough coty ADMINISTRATOR EVALUATION - Professional Development - Track 2 Fusiig scm. {[ Name: Moore,Benjamin (121670) J School Year: 2017-2018 | Divi |[ Postion Title: Dept Mgr, FacitiesMaintSuprt [Werk Location: 9811 Maintenance = Exemplary! St = Excoods Expocted Standards ‘S= Meets Expected Standards N=Needs Improvemon? U= Unsatisfactory NA=Not Applcable FORWATIVE FOBMAINE —SUMVATVE SUMMA evaltor Sol Evatt ¢nencon (in January) (Gy Nay 1) (By Mey 1) A. Profesional tributes sr _S+ St Ss B, Leadership Skills oa St Sf _at C. Organizational Skills TT St = st st D. Communication Skits _§4 St ieee oteeae E, Human Resources hianagement 5 St © _ St — F. Program/Curriculum Management G. Business Management s + Su 5 St H. Cognitive Sielis s gs ‘SPECIFIC GOALS: (Required; deny n September) Formative Comments: FEW Has BEEN A’ CREAT As: DERART MENn. FEY Expecrion ss fo M6 FF Airy, _ Summative Comments: Odssrimes 78 RE ft Fast Cons Mee 1 Aa rang reques ne arstaorexalih andreas 9 tesa parttoto vey pemance.Feececk rm mute sures requred component 2h ring ress he ovata toroid wen commas abo. + ratngYesuts nimi erent Competency Asse - Tack 2 (OVER)ASSESSMENT CRITERIA ‘A. PROFESSIONAL ATTRIBUTES 1. Updates skills and knowiedge in specialized feld 2. Displays ethical characteristics 3, Demonstrates professional atitudes 4. Sets goals that encourage selithers to higher standards 8, LEADERSHIP SKILLS 4. Adapts behavior and intracon to fit the situation let '3, Produces postive results in tho overall program. 4, Demonstrates decisiveness 5, Uses persuasiveness to influence others 6. Demonstrates group process and facilitating skil 7. Initiates actions to lead others to improve citcumstances Demonstrates organizational sensitivity ‘Acts within the shared vision, mission and values ©. ORGANIZATIONAL SKILLS 4. Delogates authority and responsibilty appropriately 2, Follows up on delegated activities 3. Schedules actives and the use of resources for accomplishing goals 4. Establishes processes to rocoive and provide feedback 5, Designs, plans, and organizes activities to achieve goals D. COMMUNICATION SKILLS 1. Wiles clearly, concisely, coroctly 2, Facilitates communication at all levels of the organization 3, Presents Information and ideas in en open, informative manner 4, Responds empathoticaly 1 other's perspectivesideas , HUMAN RESOURCES MANAGEMENT 4, Establishes high expectations for performance 2. Utilizes dletrict procedures for selection of human resources 3, Takes positive stops to upgrade staff performance 4, Assigns staff appropriately . 5, Evaluates staff according to district procedures F, PROGRAM/CURRICULUM MANAGEMENT 1. Identifes program needs 2. Develops goals and objectives 3, Developsiimploments district programs. 4, Uses physical resources effectively and efficiently 5, Monitors and evaluates program effectiveness 8, Applies evaluation findings to program management G. BUSINESS MANAGEMENT 4, Uses approved accounting methods 2, Completes reports accurately and on time 3, Expends funds appropriately and responsibly H. COGNITIVE SKILLS. 4, Gathors and analyzes data from multiple sources 2, Uses patterns and relationships o form hypotheses 3. Uses altemative or multiple perspectives in problem solving em B08 = femme BL sc | fT hepa am ZY summative [9-77 i 7) Date isretor’s Signature Evaluators Sonate Placement Recommendation: 1D Professional Development 1 Competency Assistance 9 OtheriAttach memorandum ‘Site to enter an overall assassment oF '$8 60901 (Rev. 07107), DISTRIBUTION: ORIGINAL: Human Resources PHOTOCOPIES: Adminitratr, Evaluator £ 0¢“U"Ih the Lawson Performance Review Screensuiseoacuct couny pumuesovoots =. HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM Pilboronsh omy ADMINISTRATOR EVALUATION - COMPETENCY DEVELOPMENT Beets {School Year: 2012-2013” [ Division: Facies Position Tite: Office of Supplier Dversiy Offer | Work Location: $369 —_ _ (Track 3), | Exceeds expected standards S = Meets expected standards N= Needs improvement (Not appropriate for Track 3 Summative) U= Unsatistactory NA = Not applicable in this position OR Not applicable at this time (New Leaders Only) FL 2 FS 5 i Enter Date: PROFESSIONAL ATTRIBUTES Updates skils and knowledge in specialized field Displays ethical characteristic, Demonstrates professional attitudes, ‘Sets goals that encourage seltlothers to higher standarcs. LEADERSHIP SKILLS ‘Adapts behavior and interaction to fit the situation. Promotes a positive image ofthe school and district. Produces positive results in the overall program. Demonstrates decisiveness Uses persuasivenoss to inluence others, Demonstrates group process and facitating sil Initiates actions to lead others to improve circumstances, Demonstrates organizational sensitivity ‘Acts within the shared vision, mission and values ORGANIZATIONAL SKILLS Delegates authority and responsibilty appropriately Follows up on delegated activities ‘Schedules activites and the use of resources for accomplishing goats Establishes processes to receive and provide feedback. Designs. plans, and ogarizes aces to achieve goa COMMUNICATION SKILLS 1. Wes leary, concisely, coraet 2. Faciatos conmuncaton a levels othe oganizaton i 5, Presents Information an ieee in an open, informative manner 4 Responds empatheticaly to others perspectivesdoos, | HUMAN RESOURCES MANAGEMENT Establishes high expectations for perfomance Utlzs disc procedures for selection of human resources Tokes postive sies to upgrade staf perormance Assigns staf appropriately Evalutes staf according to date! procedures,hy PROGRAM/CURRICULUM MANAGEMENT Identifies program neds : S| Develops goals and objectives 5 ar - ‘Evaluators Signature Developsfimplements dstict programs. Uses physical resources effectively and efficiently. Monitors and evaluates program effectiveness. Applies evaluation findings to pragram management BUSINESS MANAGEMENT Uses approved accounting methods. Hk Completes reports accurately and on time: 3, Expends funds appropriately and responsibly COGNITIVE SKILLS 4, Gathers and analyzes data from multiple sources. 2. Uses patterns and retationships to form hypotheses. 3. Uses alternative or multiple perspectives in problem solving. Date - iministrators Signature Ee Date TRanaraters Signatuie —_——_____Evalvators Signatire Kase) A) bran Formate [ Te some (613 UP thy Wee — ‘Date “Administrator's Signature ne a Evaluators Summative Comments: | | L jninisrator’s Summative Comments: L ‘sue 1 enter an overall assessment of S,"*N,"or"U" inthe Lawson Perfomance Review Sereen ‘$8 60902 (Rev. 07107), BISTRIBUTION: ORIGINAL: Humen Resources BHOTOCOPIES: Amiisatr, EvaluatorHillsborough County CONTRACT FOR ADMINISTRATIVE PERSONNEL, | HILLSBOROUGH COUNTY PUBLIC SCHOOLS, FLORIDA | Employee Name: Moore, Benjamin Effeative Dato: 7/1/2019 Lawaon ID: 121670, ‘School Year: 2019-2020 ‘Current Location: 9811 Maintenance ‘Status: Annual ——— caren Pamany AssIgrment” Dept Migr SeP ett es Matt Print Dato: 8/9/2019 “This fo an agreement between The Schoo! Boord of Hilsborough County Floda, (Boar), and the adinistraive personne! sted above. Tho Board ‘agrees that wil employ the employee upon the terms and conditons provided by applicable federal and state laws and any and al ther approprato Board poles, procedures, salary schedules, rules and reguiation, For positions that warant a catia, the employee hols an active professional cartficate or temporary cortical issued pursuant to Farida Stalute 1012.56 and rues ofthe State Board of Education. ‘An employee who does not provide complet information, incuding, but not ited to, certiication (f appEcabe to poston), degrees stained, or prior ‘work exparionce wll be med to up fo two years of back pay a 1 compensation thatthe employee would have been ented Rad she provided ‘completo information, “The employee agrees that he or she wil work the entire period of he service provided under the contrac. ‘The firs 97 days ofan inal contact isa probationary petiod forthe employee. During the probationary period, the employee maybe dismissed “without cause or may resign from the contractual postion without he breach of contrac. During the term of the contract the employee may be dismissed or suspended fr Just Cause, Just Cause incudes, buts not ited to, the following inetancas, as defined by rule of he State Board of Education: immoralfy, misconduct in ofc, incompetency, gross insubordination, wilful neglect ‘of Cu, drunkenness, of being convict or found guity of entering apa of uiy to, regadies of adjusication of gui, any ere involving moral tuptud. Upon recommendation ofthe Superintendent of Schools, the Board may transfer the employee to another poston provided the employee's sslary and ‘other benef ae not reducad by vitue ofthe raster. ‘The employment ofthe employee wil be, and a al mes rein, subject to th provisions of al federal an state laws and the poles, procedures, rules and regulaons promulgated bythe Board, and nathing herein is intended to nor willbe read as, amen, string, or ciminishing Such laws, poles, procedure, ules or ragulations ‘Gwen under ou hands and seals in Tampa, Florida Mes SLauleg ‘SCHOOL BOARD OF HILLSBOROUGH COUNTY, FLORIDA, ACOPY OF THE CONTRACT WiLL BE =r vue @YAFF MEMBER.HILLSBOROUGH COUNTY PUBLIC SCHOOLS ‘ ; HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM Hillsborough Count ADMINISTRATOR EVALUATION - Professional Development - Track 2 Name: Benjamin Moore ~[ Schoo! Year: 2013-2014 [ ppl Diversity Officer = Exemplary’ Excoods Expected Standards N= Needs Improvement” nsatlsfactor NA= Not Applicable Enter Date: FORMATIVE. FORMATIVE. ‘SUMMATIVE Sol ‘evatalor Set (inJenuen) indenary) (ey May) Professional Atibutes St S| Leadership Skis _S § | St st Organizational Skis _st Si Communication Skis St _@G | Ss Human Resources Management Sia ta eee eee Program/Curticulum Management ~st _—6f | st _ Business Management st Ss _s- Cognitive Ske LULU SPECIFIC GOALS: (Require: deny n September) See Sterbesic Plan = Obrectives dora-b - _ renmmoog> Formative Comments: oo "Boa 2 Cae Mette Ze aed $n" ny equ no emia: edi an atin poesia very prance, Feedback fom mule soucesisorequdconroert Ce TE safes ba WistertASSESSMENT CRITERIA ‘A, PROFESSIONAL ATTRIBUTES 1. Updates skils and knowledge in specialized field 2. Displays ethical characterstics 3, Demonstrates professional attitudes 4, Sets go: als thal encourage selfotners to higher standards B. LEADERSHIP SKILLS ‘hehawioe and interaction tof the situation Promotes a positive image ofthe school and distiict Produces pasitive results inthe overall program. Demonstrates decisiveness Demonstrates group process and facilitating skill Initetes actions to load others to improve ercumstances 2 3 4 5, Uses persuasiveness to influence others 6 7 a Demonstrates o-ganizational sensitivity ‘9, Acts within the shared vision, mission and values, C. ORGANIZATIONAL SKILLS 1. Delegates authonty and responsibilty approp:ately 2. Follows up on dolegated activites 3. Sehedules activities and tho use of resources for accomplishing goals 4. Establishes processes to receive and provide feedback 5. Designs, plans, and organizes activities to achieve goals D, COMMUNICATION SKILLS. 4, Writes clearly, concisely, corectly 2, Facilitates communication at all levels ofthe organization 3. Presents information and ideas in an open, informative manner 4, Responds empatheticaly to other's perspectivesfideas E. HUMAN RESOURCES MANAGEMENT 1. Establishes high expectations for performance 2, Ublizes clstrct procedures for soldtion of human resources 3) Takes positive steps to upgrade staff performance 4: Assigns ta poopy Evaluates staff according to district procedures F. PROGRAM/CURRICULUM MANAGEMENT 1 Identities program needs Develops goais and objectives Uses physical resouroes effectively and efficiently 1 2 3. Developsimploments district programs 4 5, Monitors and evaluates program effectiveness Applies ‘evaluation findings to program management G, BUSINESS MANAGEMENT 1. Uses approved accounting methods 2. Completes reports accurately and on time 3. Expends funds epproprately and responsibly H, COGNITIVE, ‘SKILLS. 4, Gathers and analyzes data from mutiple sources 2. Uses patterns and relationships to form hypotheses 3. Uses at itemative or muliple perspectives in problem solving Summative “é, Ziti ‘Ramingirators Signature Placement Recommendation’ 1D Professional Development 1 Competency Assistance Site to enter an overall ‘$8 80801 (Rev. 07/07) DISTRIBUTION: assessment of §,°°N,"or“U" i the Lawson Perfomance Review Screen ORIGINAL: Human Resources PHOTOCOPIES: Asmiistater, Evaluator © OtheriAttach memorandumADMINISTRATIVE PROMOTIONAL PLACEMENT WARE? FROWE SCHEDULE: | DAYS ievetD Moore, Benjamin Dept Mgr, x05 253 Mp3 SrFaclitiesMainsup : EFFECTIVE DATE: Tor —) SCHEDULE: DAYS: DEGREE LEVEL: 06/15/2020 Gen Mgr, Mantenance | XOB | 253 MD TAWSON NEW WORK LOCATION: WHEL LV: ene 121670 Maintenance 1 [ya | ‘Coripafe he PRE-PROW HOURLY RATE Box a tho baton Tis Tom ‘Determine Masters Level equivalent forthe eurent (ls) postion ‘PRE-PRONOTION MASTER'S HOURLY RATE: ‘SCHEDULE WCREASE: | PRE-PLACEMENT HOURLY RATE: $ 40.8397 3% 42.0649 CALENDAR DAYS ADJUSTMENT FACTORS: TIMES DAY FACTOR: 201/216 TO 253/257 0.9183 4 10 201 TO 2010R 25370253 1.0000, 2531287 TO 201/216, +0868 | Rarer $42.0848 | AOJUSTHENT PRE-PLACEMENT HOURLY | Find the appropriate pay cluma fo the position ans work year Determine fe new houty rales that are both above and below the ADJUSTMENT PRE-PLACEMENT HOURLY RATE from above [couuan; ———]Bavs (eorraoeraeresar2577 x08 253 SeLOWLEVEL: “ABOVE LEVEL! N/a 1 | BELOW HOURLY RATE: | ABOVE HOURLY RATE: HIDPORT: N/A $50.9304 SN/A ihe ADJUSTMENT PRE-PLACENMENT HOURLY RATE Is SMALLER than the midpoint use the BELOW level as the HOURLY RATE : ifthe ADJUSTMENT PRE-PLACEMENT HOURLY RATE is LARGER than the midpoint use the ABOVE revel as the HOURLY RATE a NOTE: I Below level minimum, place on Level 1 of respective pay a DETERMINATION OF PLACEMENT HOURLY RATE: Place on MD 1 1 | DEGREE ~ ~~] POST PROMOTIONAL |_ DIFFERENTIAL HOURLY RATE, MASTER'S HOURLY RATE } $50.9304 SPECIALIST ae LONGEVITY INCREMENT ocrorATE DEGREE DIFFERENTIAL $1.76 7 TOTALHOURLYRATE |= [— 5 $50.9304 (CADRINISTRATIVE LONGEVITY SUPPLEWENT —] vate_GeMt/a. 2.0% start ofthe 25" year of Administrative Experience 2.5% stan ofthe GO yoar of Administrative Experionce Gen Mgr Employee Relations, Fact athe 20" yoora arate | 7 ne ate | vest RepPers Anaver_ 71.3 tH _CONFIDENTIAL INFORMATION SCHOOL DISTRICT OF HILLSBOROUGH COUNTY EMPLOYEE EVALUATION (NON-REPRESENTED) pe ____ PR Code _P ____ Employee 1D Number _123670 Work Location 9831 _yaintenance Job Code and Title 54504 wr, maine. unit _ Rating Period 07/02/2006 to _06/30/2007, Rating Purpose: (x) Annual ( ) Probationary ) Extended Probation/Promotion ( ) Career Observation ‘conference chs eration iliac «review ond ication betwoun tho eater and tbe ESP employee ofthe tem sed below S~-Satisfactory NI- Needs Improvement __U - Unsatisfactory NA - Not Applicable Self Evaluation eee SECTION I Ni[ U0 TNATS | Ni] U QUANTITY | 1, Uses ne mppropialy to proce wrk 2 Compleas eslnrents on tine QUALITY i 3, Keaccuate 4, Shows videos of pinning ad thoroohoest 5. Show nesnes fa week 6, Follows éirstns i 1. Shows sila banding speci! ssigamentsfrusulsutins {8 Works with minimal amoust of eupervtion witha job doserption PROFESSIONAL PERFORMANCE | 9, Handles cote nfreaton appropsaely 10, Ie knowladgeble abou progran/depertmeat 11, Uses fsrutonltclgues and materi efetvely 12, Demat al in saitng in management of stdets 1, Mulnains empport wih oter employees 14. Malation epport wih stadets 15, Matin rppot wit choo - related commanty 16, Accepts and flows soggestins 17, Some aie 1, Shows enthuse for he positon 19, te roular in atendnce 20, ts pects . 21, Dresses aporoplay for tk involved 7 ‘3 “Indicates comments are noted on reverse side or on attachment. ‘870530 Rev. 2/17/2004 (Over)RATER’S COMMENTS: (ii applicasie) S CK ADMETSMRATOR FoR A. Exceptional Qualities: __.____. B, ECT RATER’S RECOMMENDATIONS: (A, Annual evaluation Satisfactory () Place on career development/czreer observation... ______._ () Release from extended probati:nary, extended promotional ( ) Release from career development, career observation, release step increase if scheduled (.). Retain on career development, extended probationary, extended promotional O () O Unsuccessful promotional observation period - return to previous classification Receive administrative transfer Dismiss as of __. SUPERVISORY REVIEW: (if applicable) Thave reviewed this report and( agree _(_) disagree. Where reviewer disagrees, specific comments are required. REVIEWER'S COMMENTS: (if applicable) Date Reviewer's Signature Title ——_ i os : Ss ee EMPLOYEE'S VERIFICATION Thave reviewed this rating report and have discussed it with the rater and have been given the opportunity to discuss it with the reviewing supervisor. Signature of employce does not necessarily imply agreement with evaluation. Employee has the option to submit an addendum to the evaluation, Date Employee's Signature Distribution: Personnel Employee —_—_—Rater/Reviewer ‘Send original to Personnel. Make copies for distribution as noted above,SCHOOL DISTRICT OF HILLSBOROUGH COUNTY, FLORIDA HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM DISTRICT ADMINISTRATOR EVALUATION - Professional Development - Track 2 Name Mooce, Bewiyewin year: 206-07 work Location, 4811 Maiwkenance Position Mae, Maintenance Unit Division: Facilites E = Exemplary! A S+ = Exceeds Expested Standards S = Meets Expected Standards Noa Nees Improvement? U= Unsatisfactory A= Not Applicable FORMATIVE “FORMATIVE © SUMMATIVE. © suMarive sat raluter sal alate eee nee a 7 2. esd Sit mana es Crp a wT Te D. Camuncton Sil es _ oe = < eer eer crcecsers cman ieee ce Bans Magee TT Te < 1. Coptve Sil meres cera |e S SPECIFIC COALS pints Atbache} ‘Summative Comments: _ Athoched ‘Ante mung egues the cealator co prvie rien commen above SA" igen iedae pce in Compete Aan Trek 3,[ASSESSMENT CRITERIA ‘A. PROFESSIONAL ATTRIBUTES 1. Updates skills and knowledge in specialized field — 2. Displays ethical characteristics 3. Demonstrates professional attitudes 4. Sete goals that encourage selffothers to higher standards B, LEADERSHIP SKILLS 1, Adapts behavior and interaction to fit the situation Promotes a positive Image of the school and district Produces positive results in the overall program: Demonstrates decisiveness Uses persuasiveness to influence others Demonstrates group process and facilitating skill Initiates actions to lead others to improve circumstances Demonstrates organizational sensitivity ‘Acts within the shared vision, mission and values C. ORGANIZATIONAL SKILLS 1. Delegates authority and responsibility appropriately 2. Follows up on delegated activities 3. Schedules activities and the use of resources for accomplishing goals 4. Establishes processes to receive and provide feedback 5. Designs, plans, and organizes activities to achieve goals D. COMMUNICATION SKILLS 1. Writes clearly, concisely, correctly 2) Facilitates communication at al levels ofthe organization. 3, Presents information and ideas in an open, informative manner 4. Responds empathetically to other's perspectives/ideas E. HUMAN RESOURCES MANAGEMENT 1. Establishes high expectations for performance 2) Utilizes district procedures for selection of human resources 43. Takes positive steps to upgrade staff performance 4. Assigns staff appropriately SS, Evaluates staff according to district procedures PROGRAM/CURRICULUM MANAGEMENT Identifies program needs Develops goals and objectives Developw/implements district programs ‘Uses physical resources effectively and efficiently Monitors and evaluates program effectiveness Applies evaluation findings to program management G. BUSINESS MANAGEMENT 1. Uses approved accounting methods 2. Completes reports accurately and on time 3. Expends funds appropriately and responsibly H, COGNITIVE SIILLS 1. Gathers and analyzes data from multiple sources 2. Uses patterns and relationships to form hypotheses 3, Uses alternative or multiple perspectives in problem sohving Formative Date Tp Maministeators Signature ‘Administrator's Signature Placement Recommendation: 1 Protessionat Development — CV Competency Assistance J othevatthen memorandum, SERMON” onsciat qwnie ene! ier of Har esac PuOTOCOIMES: Aspe Eossno™ Apopseitin SepiaADDENDUM TO 2006-07 E° BEN MOORE, AREA MAINTENANCE MANAGER, MAINTENANCE WEST. ALUATION SPECIFIC GOALS: 1)__Reduce Department’s backlog of routine and urgent work _ Ss ‘y- Conlinue fo improve Department's customer service ratings for tinretin and quality towards goal of 4.5 or better 3)_Reduce Department's accident rate and workmen's compensation clai 4) Continuously improve Department efficiency 5) Adequately plan for replacement and renovation of supported facilities, as measured by: a, Ratio of unplanned to planned replacements b. Continual increase in customer satisfaction with their facility COMMENTS: * Successful first year as Department manager. © Department achieved targets for backlog reduction during the year, one of a few departments to do so, However, average completion times increased slightly, when compared to the previous year. ‘* Available customer ratings for timeliness and quality were obtained before Ben’s tenure. ‘Ancedotal evidence indicates that, at a minimum, previous levels of customer satisfaction have been maintained. «Safety incidents increased 25% in past year, when compared to the previous year. ‘© Employee morale appears generally higher than that of other Departments; HSEF issues are rare, ‘Department inventory stocks decreased slightly from 2005-06 levels, in line with objectives. Department was only one to register a decrease © Department plans well for facility improvements. «Records reflect no required purchase audits were completed during the rated period «Limited measures of efficiency available; primary focus has been on customer satisfaction, backlog reduction, and response time. Department took some positive steps towards efficiency improvements during the year, particularly in the area of reducing travel time.ANNUAL GOALS 2007-08 BEN MOORE AREA MAINTENANCE MANAGER, MAINTENANCE WEST. SPECIFIC GOAL! {1} Reduce Department's backlog of routine and urgent work a, Decrease routine Service Orders OVEr 30 days Od by 50% ’. Continue to reduce average response time for both urgent and routine requirements 2) Continue to improve Department's customer service ratings for timeliness and quality towards goal of 4.5 or better 3)_Reduce Department's 2 4) Continuously improve Department efficiency, as measured by: a, Reduction in travel time b, Increase in contract services at a rate less than the rate of growth in facilities ent rate and workmen's compensation claims 3) Adequately plan for major repairs of supported schools, as measured by: a, Ratio of unplanned to planned major repairs ». Continual increase in customer satisfaction with the condition of their facilitiesHillsborough. CONTRACT FOR ADMINISTRATIVE PERSONNEL HILLSBOROUGH COUNTY PUBLIC SCHOOLS, FLORIDA Employee Name: Moore, Benjamin Effective Date: 7172020 Lawson: 670 School Year: 2020-2024 urrent Location: 9811 Maintenance aimee Print Date: 7/22/2020 : ‘This an agreement between The Schoo! Board of Hilsborough County Florida, "Board), andthe administrative personne sted sbove, The Board agrees that wil employ the employee upon the terme and condklons provided by applicable federal and state laws and any anal other appropriate Board poles, procedures, salary schedUles, rules and regulations. For postions thal waren ceticae, the employee hols an active professional cotficate or temporary certfcat ued pursuant to Florida Statut 1012.56 and ues ofthe State Board of Education, ‘An employee who does not provide complete information Induding, but not med to, cartication (f applicable to postion), degrees attained, o por ‘Work experience wil be limited to up o two years of back pay as fo compensation thatthe employee would have been ented had hefshe provided ‘complete information, ‘The empioyee agrees that he or she wil work the ene period ofthe servic provided under the contrat. ‘Tho fis 97 days ofan inal contact isa probationary period forthe employee. During the probationary period, the employee may be dismissed without cause or may resign fom the contractual postion without the breach of contract. During the term of the contract the employee may be damissed or suspended for just cause, Just cause includes, buts not iid to, he following instances, 28 defined by rue of the State Board of Education immorality, misconduct in ffie, incompetency gross insubordination, wif neglect of duty, drunkenness, or belng convicted or found guty of entering a pla of gully fo, regardless of acjudcation of gui, ary cre involving moral ‘uephude. Upon recommendation of he Superintendent of Schools, the Board may transfer the employee to another positon provided the employee's salary and ‘other benefits are not reduced by vitue of the transfer. “The employment of the employee willbe, and at al imos remain, subject tothe provision of al federal and stato laws and the pons, procedures, ‘ules and equations promulgated by the Board, and nothing herein is intended to nor wil be reads, amending altering, oF diminishing such laws, policies, procedures, ules or regulations ‘Seat ember Signature [ACOPY OF THE CONTRACT WILL BE ‘SCHOOL BOARD OF HILLSBOROUGH COUNTY, FLORIOA PROVIDED TO THE STAFF MEMBERHILLSBOROUGH COUNTY PUBLIC SCHOOLS HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM ADMINISTRATOR EVALUATION - Professional Development - Track 2 ‘Name: Berjamin Moore “[ School Year: 2014-2016 Hillsborough Couney Oi itn [Postion Tite Ofc Supe Dhersy Ofser | Work Location ‘S+= Excoods Expected Standards 'U= Unsatisfactoy” "9369 - Ofico of Supplier Diversity joots Expected Standards 'NA= Not Applicable Enter Date FORMATIVE “FORMATIVE SUMMATIVE —SUMMATIVE (inJonvay) (idonsay) eytiny) vay) A. Professional Attributes 5+ sh B. Leadership Skills st masa 6. Organizational Skits Sts? D. Communication Skills ot _sf E. Human Resources Management Soca ee F. Program/Curriculum Management “SF st G. Business Management St _ st H. Cognitive Skills ot ase _ SPECIFIC GOALS: (Required; identity in September.) Formative Comments: ‘Summative Comments fhe, Moore Ken dome Ra pdt of Ke EAN ang res fe evaluat to rose ton conor ave SAN aang eats in mediate pasemont in Campetancy Aastnee = Tak 3 (OVER) OYfPanch ny rating vequres the aminirator estab od ean a preasinal pont ovesty promance.Feeehack om mull soiree is rogue componentASSESSMENT CRITERIA A. PROFESSIONAL ATTRIBUTES 1. Updates skis and knowledge in specializod old 2, Displays ethical characteristics 3, Demonstrates professional atttudes 4. Sets goals that encourage solffothers to higher standards 8. LEADERSHIP SKILLS 4. Adapis behavior and interaction to fit the situation PrOMOTeS a POSTIVE TE 3, Produces positive results in the overall program. 4, Demonstrates decisiveness 55, Uses porsuasiveness 10 influence others 6, Demonstrates group process and facilitating ski 7, Initiates actions lo lead others to improve circumstances. 8. Demonstrates organizational sensitivity 9, Acts within the shared vision, mission and values (©. ORGANIZATIONAL SKILLS 1. Delegates authority and responsibilty appropriately 2. Follows up on delegated activities 3. Schedulas activitias end the use of resources for accomplishing goals 4, Establishes procossos to recolve and provide feedback. 5. Designs, plans, and organizes actives to achieve goals D. COMMUNICATION SKILLS 1, Writes clearly, concisely, correctly 2. Facilitates communication at all evels ofthe organization 43, Presents information and ideas in an open, informative manner 4. Responds empathelically to other's perspectves/idews E, HUMAN RESOURCES MANAGEMENT 1. Establishes high expectations for performance 2. Utlizes disivict procedures for selection of human resources 3. Takes positive steps lo upgrade staff porformance 4. Assigns staff appropriately 5, Evaluates staff according to district procedures F. PROGRAM/CURRICULUM MANAGEMENT 1. Identifies program needs 2. Develops goals and objectives 3. Develops/implements district programs 14. Uses physical resources effectively and efficiently 5, Monitors and evaluates program effectiveness 6. Applies evaluation findings to program management G. BUSINESS MANAGEMENT 4, Uses approved accounting methods 2. Completes coparts accurately and on time ‘3, Expands funds appropriately and responsibly H, COGNITIVE SKILLS 4, Gathers and analyzes data from mutiple sources 2. Uses patterns and relationships to form hypotheses 33. Uses altemative or multiple perspectives in prabiem solving Format T— | mee (eae Bila aaa ‘Summative [ Placement Recommendation: C1 Professional Development 1B Competency Assistance © Othedattach memorandum Sie 10 enter an overall assessment of“ '8B.6090% (Rev. 07107), DISTRIGUTION: ORIGINAL: Human Resources PHOTOCOPIES: Administrator, Evaluator NP oF"U" inthe Lawson Performance Review Screeny. 6 SawWSOr) 2G NT HILLSBOROUGH COUNTY PUBLIC SCHOOLS HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT SYSTEM sean 8 ADMINISTRATOR EVALUATION - Professional Development - Track 2 ee Statin (Name: Moore, Benjamin (121670) [School Year: 2016-2017 | Division: D-FAC Mgr, FeclitiesMeintSuprt | Work Location: 9811 Maintenance = Exemplary! S+ = Exceeds Expected Standards ‘$= Moots Expacted Standards N= Needs improvement? U= Unsatisfacton NA= Not Applicable EntarDate: 19. -(9. Qapey EOBMATIVE EORMATIVE ‘SUMMATVE ‘Sot Evaluator Saif Evalustor (ndanuary) (invenuay) (By May 1) By Moy 1) Professional Attributes 4 cae A jf st Leadership Skis A B . Organizational Skills St Ss. D. Communication Skills st St E, Human Resources Management jae Ss t F, Program/Curiculum Management st S+ G. Business Management 5 cia st H. Cognitive Skills St 6f SPECIFIC GOALS: (Required; identity in September) Formative Comments: BEN 130 ba THLE 76 RE THE NEXT CIN Fan (AWE. Hae WakkéR Th ees ‘Summative Commonts: 2 An-3¢ ag else erature R'E ang esuteN mediate paceme In Competeney Aeseancs Teck (OVER) ‘Stoo rter an overall sseesmont of S,"°N,"or“U"n the Lawson Performance Review Screen ORIGINAL: Human Resources PHOTOCOPIES: Administrator, EvaluatorASSESSMENT CRITERIA ‘A. PROFESSIONAL ATTRIBUTES 1. Updatos skils and knowledge in specialized Nels 2. Displays ethical characteristics 3, Demonstrates professional atitudes 4, Demonstrates decisiveness 5. Uses persuasiveness to Influence others 8. Demonstrates group process and faciitating sk 7, Intltes actions to lead others to Improve croumstances 8. Demonstrates organizational sensitivity 9, Acts within the shared vision, mission and values, : ©, ORGANIZATIONAL SKILLS: 1, Delogates authorty snd responsioity appropriately 2. Folows up on delogated activites: 23 Schedules actives and the use of resources for accomplishing goals 44, Establishes processes to receive and provide feedback 8. Designs, plans, and organizes actvtles to achieve goals, , COMMUNICATION SKILLS: ° 1. Whites clearly, concisely, correctly 2; Faclitates communication at all lvels of the organization 3, Presents Information and ideas In an open, informative manner ‘4, Rasponds empathetically to other's perspectives/idees E, HUMAN RESOURCES MANAGEMENT. 1. Establishes high expectations for performance 2. Unlizes alstict procedures for selection of human resources 43, Takes postive steps to upgrade staff performance 4. Assigns staf appropriately 5, EvalUates staff according to distct procedures, F, PROGRAM/CURRICULUM MANAGEMENT 1. Identifies program needs 2. Davolops goals and objectives. 3, Devolopsimplements district programs Uses physical resources effectivaly and offictentiy ‘Monitors and evaluates program affectveness 5, Applies evaluation findings to program mana @. BUSINESS MANAGEMENT 1, Uses approved accounting methods 2. Completes reports accurately and on time . 3, Exponds funds appropriately and responsibly H, COGNITIVE SKILLS 1. Gathers and analyzes deta trom multiple sources 2. Uses pattams and relationships to form hypotheses: 3, Uses altemative or muliple perspectives n problem solving ent — capes fe ‘Adil ‘Evaluators Signature ‘Summative Data ‘aiminictrators Signatire Evaluators Signature ‘Placement Recommendation: 10 Professional Development 0 Competency Assistance 10 Other/Atach memorandum ‘Soto ertar an overs astosement of °5,°°N,"or°U"n tha Lawaon Perfomance Review Screan ‘$B 60001 (Rev. 0707) DISTRIBUTION: . ORIGINAL: Human Resources PHOTOCOPIES: Asminisrtor, EvaluatorQ252| oo “WANE (for SCHOOL BOARD 0} PERSONNEL fii TERE —I F HILLSBOROUGH COUNTY ASSIGNMENT FORM ACTION CODES- QI-INITIAL EMPL 07-JOB RECLASS 03-LOA W/O PAY 09-JOB CHANGE EMPLOYER 1b [DATE [ACTOR O4-RETRN FR LOA 10-TRANSFER OUT 05-SEPARATION 11-OTHER CHG x 24126 1 21 L 06-PROMOTION 12=CORRECTION EMPLOYEE NAME SOFFIR) ac STATUS LEAVE EMPLOYMENT TYPE HOWE DED col pare _|sepx col secin | rary pare | empi| pepr | p/1| scHED AD ae Ls ZL ele x |ilil | JOB ASSIGNMENT Aso PAY} ——soB JOR ENTRY DAYS) Ri} HOURS | TH] ASSIGNMENT NO| CLS] CLASS BEGIN END | EMPL] 10] DAY | CD|_BEGIN END =r OU LL - LLL | xxsuxsrn) xx/xx/xxl | | [xxl xxaxl xf xx] 7 / ey. ‘APPT POST] BASE ‘SUPPLEMEN’ TOTAL DEPT] NO | GRo| st PAY RATE satary | sacary | sanany | unr -2 LLL Tid aio al al A | xxxay xl ANNUAL | PROBATION’ SAL —C7S | ~POOL| Corel? SRO pare | pate | _exc|_cops|_IND -3 04n384 Tee | ERA| RATE STFEL FRO FONC| Oay| PROG PRa| PERCENT] START [SOP “T DAY] moti) at tol ed P a | P ex ce/ nel x70 23 -5{tl a oti tu Liitit a XX/XX/XX] XX/XX/XX| XXX ~6 LLL Al toiiitit LLITT IIT A || xx/xx/xx] xx/xx/xx] xxx) -7 LL AL oT || xx/xx/xx] xx/xx/xx] Xxx) -8 al loiil ipa Witt A |_| xxsxx/xx] xx/xx/xx] x0! -9 LL Litt titi ttt |_| xx/ux/xxl xx/xx/xx] xxx] SB FORM 00144 03/01/83 AI L-SHOTHILLSBOROUGH COUNTY PUBLIC SCHOOLS INICATION DATE October 29, 1984 fQ: Benjamin’Moore, Lomay) Elementary Schoo) ERO natd W. Tindle, Director, Non-Instructional Personnel % Security SUBIERT-CustodialPool Pt t After review of the new custodial unit allocation, you have been identified ‘as the employee who will come to the custodial placement poo) from vour work site. This pool will take place on Friday, November 2, 1984 at 9:00 a.m. in the Personnel Conference Room at the School Administrative Center. The “School Administrative Center is located at 90] E. Kennedy, and the Personnel Conference Room is on the Second floor. At the pool, you will be able to choose by seniority from a list of full time and part time vacancies at schools all over the county. Mr. Fernandez will be there to assist us in this placement. You must attend this pool, and we suggest you come early. If you have any questions, please contact us. RWT: sf ce:. PrincipalSCHOOL DISTRICT OF HILLSBOROUGH COUNTY REPORT OF APPOINTMENT OR CHANGE OF STATUS Neen eee 10/15/99 FIRST MODLE DATE PREPARED —1oAn7g5 PRO. 9 SOCIAL” SECURITY -NOz HON AT RST. TAMPA EL 33617 P TADORESS PLAGE OF WORK PAYROLL CODE X_ MALE ___ FEMALE SINGLE MARRIED Z EFFECTIVE DATE ENPLOVEE NO. |_t.witTE .X2.BLACK _3.HISPANIC _4.ASIAN/ Pale FROM 0 To SUCGEED // DATE (NAME) VACATED Position Number [ 9815/076 9813/076 Glass Tile MIWK MTWK Glass Code 475 4 Grade ieee lee 26 Step 09 10 Hourly Rate 14.940" 15.400 ‘Annual Salan 29,282.40 30,184.00 7 Mos. Work/Yoor 12. "12. HOURLY HOURLY ‘TYPE OF APPOINTMENT ACTION ‘TERMINATIONS X__ Permanent Acting Appointment ___ Probationary Merit —— Deceased Hours por day KL Annual Merit —— Fromotion — Dismissed —— Claes Rearaded Remove from Acting —— Resigned — Demetion Return from Leave Retired = Leave of Absence Return to Former Duty — original Appointment Transfer Position Reclassified —_X_ Other: ADJ Benefits Date: 1.00 PERCENT SALARY ADJUSTMENT INCREASE - 1999-00SCHOOL DISTRICT OF HILLSBOROUGH COUNTY REPORT OF APPOINTMENT OR CHANGE OF STATUS Fe NAME, LAST FIRST MADDLE DATE PREPARED = 10/10/65 | MAINT 2 122 [SOCIAL SECURITY NO; i SEPARTMERT. TH AVE TAMPA FL 33605 P ‘ADDRESS PLACE OF WORK PAYROLL CODE Xk MALE FEMALE SINGLE marnicD ||_97/0129 EFFECTIVE DATE EWPLOVEE NO. L_t.wHTe X2.8LACK _3.HISPANC _4.ASIAN/ __5.AM.IND./ Pal. Ne FROM To TO SUCCEED // DATE (NAME) VACATED Position Number 12270) 0122/0256 Glass Title “PNIR: PNTR2 Glass Code 4731 4731 Grade 22 Step 04 o4 Hourly Rate: 0.840 71.540 ‘Annual Salary # Mos. Work/Year | 1 L WOURLY HOURLY TYPE OF APPOINTMENT ‘ACTION ‘TERMINATIONS —X% Permanent — Acting Appointment —__ Probationary Merit —— Deceased —— Hours per day — Annual Merit — Promotion — Dismissed — class Regraded —— Remove from Acting — Resigned emotion — Return from Leave Retired Leave of Absence Return to Former Duty — Original Appointment Transfer Position Reclassified X other: ADS Benefits Date: Salary Review Dat 4.6 PERCENT COL SALARY ADJUSTMENT INCLUDED (1993-94)18 Pa Aes SCHOOL DISTRICT OF HILLSBOROUGH COUNTY PERSONNEL ASSIGNMENT FORM MOORE, BENJAMIN WAWE (FOR FILING ONLY) OLINTEMP —05-SEPRTN 09-JOB CHG OZLOAWIPAY 06-PROMTN 10-TRANS OUT EUPLOYEETO [ACTIONS NAVE ‘SUFFI SATS — eR jeLOVMENT—[-GONTINUOUS —[—“ORIGINA, oo. DATE SEPR cD BEGIN THRU DATE EMPLOYMENT | EMPLOYMENT ie i 1 1 TW TL TT ‘STREET ADDRESS ony oT iP COE ‘AREA PHONE OMEGF [IV] VACATION | _ RETIREMENT] FIOA | ENP | DED sex_| ETH BIRTH _| SH DATE [PUN RATE | CODE| TYP | SCH ® TT 1 y {JOB ASSIGNMENT i a6 ] PAY ‘CURRENT JOB POSITION. pays | RT] HOURS] Te ASSIGNMENT ' no | cis cuss BEGN | ENO | ewer | 10 | Day | CO BEGIN ENO +04 >= v 05/03/98 TT 05/03/98, 7 BASE | SUPPLEMENT | TOTAL aget | AGS™ | oro_| sr_| pavrate | satay SALARY SALARY ‘annual | proaarion | sac | cs | Poot! 1 ATE, DATE Exe_| cove | No. adl eRN [site | eno] runc | ons | proc | pri [PERCENT 4 PROM PAINTER TO NTVIKI EFF: s ai98 awe WAY ft 1998 :BEP) ____ SB 0044 6370903 = ORIG. COPY EDB PROCESS DATE. 08/08/98i Repo No: HRI059 Ran Dae: 2972010 g Hiishorough County CONFIDENTIAL INFORMATION Bienes NON-REPRESENTED EMPLOYEE EVALUATION Employee Name Benjamin Moore PAR Code :P Lawson Number 121670 Work Location 9811 Maintenance Job Code and Title 54504 Mgr, Maint. Unit RatingPeriod 7/1/2009 to _6302010, Rating Purpose: (X) Annual (Probationary (_) Extended Probation/Promotion _( ) Career Observation ‘Aconference on ths evaluation will jclude review and discussion between the rater andthe employee of the items listed below. S—Satsactory _-NI-Needs Improvement U~ Unsalsctory NA-Not Applicable Seif Bvaluation peered ? SE oN s | NI] U|NA] S {NI} U [NA § Quantity F 1s ven pay ops - “pe 2, Competes cssignments on tine QUALITY 3. Is accurate 4, Shows evidence of planning and thoroughness 5. Shows neatness in work 6 4 Follows directions Shows ski in handling special sssignments/unusual situations ) Si 4 3 3 '8. Works with minimal amount of supervision within job description PROFESSIONAL PERFORMANCE. 9, Handles confidential information appropriately 10, 1s knowledgeable about program/department 1, Uses instructional techniques and materials effectively 12, Demonstrates skil in assisting in management of students 13. Maintains rapport with other employees 14, Maintains rapport with students 15, Maintains rapport with school — related community 16, Accepts and follows suggestions 17. Shows initiative 18, Shows enthusiasm forthe position 19, Is regular in attendance 20. Is punctual 21. Dresses appropriately for task involved ANAND ARN ASAAAS tt 4 3g g 1 ‘stcaes Comune are noted oi Niven side or on incl 8370530 Rev. 8/16/2006[Te on e131 le khig Procpst S's Ano + ENTS: (Sanpliendisy ©) Annual evaluation is overall satisfactory 2 slaus i {Release om probatior } Unsuccessful intial probationary period (Extend probatoa; attach copy of wellen notification to employee attach copy of written notification to employee (Dismiss as of { }) Unsuceessfil promotional observation peviod () Bxtend promotional observation periods attach copy of written notification to employee (Return to previous classification: attach copy of written notation to employee (-) Place on Career bserration- Level Is attach copy of written notification to employee {Place on Career Observation - Level 2 atte copy of writen notification to employee ese lop reas if sede ( } Rolease rom Career Observation Reviewer's Signature _. tide we reviewed ths rating report anc have discussed it with te rater and have besp- giro The opportunity to discuss it with he fing speci, Site of payee ees at cs inl ew reat, Employes hs the open ‘fit an addendum fo the evaluation ste SfJAZLL2 ras inners Gi Phe Distiboton: Personnel Serves Enphyee RatevReviewer Send ginal io Person ROSSAC, Route 7- ke copies for dstbtion as noted oveeR Ie Ba “th ? 0 -— Avent Gare X ¥ AMENDMENT TO EMPLOYMENT CONTRACT ee Friis AGREEMENT, Made and entered into this 4f aay ot BZ ____,a.0,, 19 PF by and betweoen THE SCHOOL BOARD OF HILLSHOROUGH COUNTY; FLORIDA; eet etre tor the Botan LEA Ti tnt PTO hetenafter referred to as the Employee. on wore WITNESSETH WHEREAS, the Board and the Employee wish to amend the contract of employment hereinbefore entered into between the Board and Revenue Code, as amended; . NOW, THEREFORE, in consideration of the premises and the mutual undertaking and agreements herein contained and assumed, the Board and the Employee hereby covenant and agree as follows 1. fective with expect to smouns emed bythe employes bing wit he ist scheduled paydte n_ 22 1984 ve Bord stl eee the employe’ sary by So eL de sr prs 2 gtr wide te ee deo a ‘ment contract year (uly 1 through June 30), which is an annualized reduction of $ \ ' . Ptrisina new contract i BAD COPY Suess” ws ems | This is decrease from to per paydate 2, tm considecation of the reduosd salary the Board wil ay «o FAA Ln in Sey eee sand foil sree ua fo We amount ofthe any rluaion fo provide omen! Carrey arr avee bued onthe peowbion of Section 403(0) ofthe intemal Reveve Cole ameeded 3, This Agreement shall be legally binding and irrevocable as to both of the parties hereto while employment continues; provided; however, that either party may change or terminate this agreement by giving notice in writing atleast 30 days prior to the effective date of said change or termination, and provided, further, that no more than one agreement for such salary reduction may be made within any fanable calendar year except to the extent otherwise permitted under Section 403(b) of the Inicinal Revenue Code, as amended; however, that in the event the amount of earnings due the Employee dusing any scheduled pay period shall be insufficient to pay the corresponding installment (as prescribed in paragraph I of thls agréement), or in the event the Board fails because of error to make said reduction, then the amount of reduction provided for in paragraph I of this agreement shall be reduced by the amount of said installment or installments not paid. i 4. ‘This amendment to the undersigned Employee's employment contract shall remain in full force for the duration of said employ- | ‘ment contract unless specifically changed or terminated in accordance with the provisions of paragraph 3 as hereinabove stated. 5, ‘That except as herein set forth, the contract of employment of the undersigned Employee is not otherwise amended and’ shall sain in full force and effect. (BSB 6. the Employee releaes all rghts, present or future, to receive payment from the Board of sad sum except (1) the right of Emm love's estate upon hisfher death while in the the Board's employ, or (2) the right personally upon termination of Employee's employ- | Beat by weaton her tnan hier death, fo receive all or eny prt of te amount herein spected for which undersigned Employes has ea uit ut echt tic be appl Wh phase anny Seas cront i 7. This agreement shall impose no liability or responsibility whatsoever on the Board except {6 make salary reductions and remit payments for-the purposes as hereinabove provided, — 8, The Binployee certifies as true and correct to his/her best knowledge and belief the personel data herein which may be used to compute the maximum exclusion allowance. IN WITNESS WHEREOF, the partes hereto have hereunto setter handsand sas tht_F day of__@C7 _, AD. 19S —— EMPLOYEE'S PERSONAL DATA: {IPLSBOROUGH COUNTY, FLORIDA | § Annual salarys 9,4 x Years Employed By Rowsd—_ J i ‘Ag Neatst Birthday Lk tte dy 4 M Sa | [aia Amount of ast, wanes ‘eta = tx Deferred Contbutone —= oe BN UR GF FORTS ——— “Tax Deferred Contributions sO. PLAN Social Security Number SISTRIRUTION:. , LNHUEINSURANCe OFS, . Lig weet a