UNIFIED SCHOOL DISTRICT NO.

1 OF RACINE COUNTY
2230 Northwestern Avenue Racine, Wisconsin 53404 Office of Director of Personnel Application of

Last

First

Middle

City

Date of Filing Application

1O

FOR OFFICE USE ONLY

Salary

Step & Level

School 'Assignment

Starting Date

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Acct. #

Acct.

APPLICATION BLANK
I. Name in Full _. Last If married, maiden n o m e _ Present A d d r e s s .Social Security No. First Middle

General Health jQHjj^pft- Estimate of occupational time lost due to illness during the last five years Any d e f e c t s in sight,or hearing? Any other physical defects? Any mental or nervous problems requiring treatment? Marital Status: Single i^ Married Widow

Number and ages of children Are you a citizen of the United States of America? By birth? V ? , By naturalization? Place

II. Present Position Grade and Subject Present Salary School

When can you accept a position?

When does your present contract expire? Position desired: Elementary Kindergarten to Grade 6, Inclusive What grade? First Choice Second Choice Junior High School What subject? Senior High School What subject? Other

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tfl*>TORY
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If elementary, can you teach music

phy. ed..
'

in own classroom?

Are you certified to teach in the State of Wisconsin?

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Are you willing to come to Racine for an interview at your own expense? III. EDUCATIONAL PREPARATION PRIOR TO BEGINNING TEACHING School Elementary High School College/ University College/ University College/ University
Major

Na

Dates Attended

Location

Specialization or Nature of Course Completed

Degree or Diploma

Date Graduated

Mino

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--T - r -j r ^<iffits&"ft"L ~~~ Sf f~FT (r- c"t Underline scholastic overages ot undergraduate college work:

IV. EDUCATIONAL TRAINING RECEIVED AFTER BEGINNING TEACHING

Institution Dotes Attended Specialization or Nature of Course Followed Degree or Diploma Dare Graduated

V. EDUCATIONAL EXPERIENCE (Do not include intern or practice teaching) No. Years Taught 3 fuMM-K!S Annual Salary

Years

Name of School

Address

Specific Nature of Position -J-tJTOfZ, UPtV/teP P&OJW 00UMP

19^-19^

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$9-101

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19 19 19 19

-19 -19 -19 -19

VI. OTHER PROFESSIONAL EXPERIENCES (Educational Travel, Lecturing, Study, Publications, Organizations ... . ) Dates Nature of Experience Time

Vtl. ARMED SERVICE RECORD

V

Dates

Branch of Service

T o t a l months in s e r v i c e

'

Honorable discharge? ._

VIII. INTERESTS AND HOBBIES

Indicate below any interests or hobbies you may have outside the professional field.
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Underline any of the following activities which you can direct successfully. Orchestra, Band, Glee Club, Debate, Forensics, Dramatics,Football, Basketball, Baseball, Track. Tennis, Soccer, Boxing, Wrestling, Gymnastics, Swimming, School Newspaper, Literary, Magazine, Annual, Others List any college activities in which you engaged which may have prepared you to direct any of the above underlined activities.

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List all the elective positions you have held (as student; in civic and professional life)

List the lodges, clubs, societies, etc., to which you belong.

JL

Indicate briefly what professional or general magazine and book reading you have done in^the past^six months,

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IX. OTHER WORK EXPERIENCE (Business, trades, summer occupations, church work, social services, scouting, recreation, etc.) Dates Firm or Institution Nature of Work No. of Months

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X. REFERENCES (Give the names of those who have closely observed your work as a teacher or employee or as a student. Do not enclose letters of reference.)

XI. GENERAL (If you wish, give any additional information which you think might be of value in our considering you for a position In the Unified School District No. 1 of Racine County.) Have you ever been arrested or indicted for or convicted of any violations of the law? If so, state name of court, nature of offense, disposition of case and date. (Disregard minor traffic violations.)

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Place Your Photograph Here,

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I certify that all answers to questions in this application are true and complete. I agree that any mi sstatement of material fact is cause for rejection, and for termination of employment.

Signe Applicant

UNIFIED SCHOOL DISTRICT NO. 1 OF RACINE COUNTY

BOARD OF EDUCATION RACINE, WISCONSIN

NOTICE OF APPOINTMENT

TO:

JOHN LEHMAN

You are hereby notified that you have been appointed to a position in the Unified School District No. 1 of Racine County for the ensuing year, beginning January 25, W71 and ending JUM 10, 1971

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for which school year of services properly rendered you are to receive an annual salary of: $ 7500 level IV step I provided that:

You will provide evidence that you are legally qualified to fill the position through license or certificate as required by the laws of the State of Wisconsin, You will agree to abide by all rules and regulations now existing or which may hereafter and before termination of this contract be authorized or adopted by the Board of Education. You will be in a satisfactory state of health as indicated by an examination by a member of the Board of Education approved examining panel as required and paid for by the Board of Education,
X

This contract is subject to the provisions of the laws of Wisconsin governing Teachers' Insurance and Retirement Fund and will be void unless a signed copy is received in the Office of the Superintendent of Schools within ten days of this date.

DATED

Ncvrohy 18 T 1970 BOARD OF EDUCATION

By
SUPERINTENDENT OF SCHOOLS

ACCEPTANCE
I hereby accept ihe effects stated in this contract and agree to abide by its provisions, and I certify that I was born ot 10^^*^^
/

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BOARD OF EDUCATION COPY

Octobr M, MM

Mr.
Please complete the enclosed application bUak and hv you* placement credentials forwarded t9 . After wt hov rcetivedi ytov ^f liMttvo Mtf ci*datUl* and hav h4 us tyiwUnity t rviw thi, M will wmtBOt you ff ptttMAi tnterriw la dwlni. MMMnitjr, ai bUv ttott tb ffoiftd Btbeol DUftrtot of f rt any fjp*rftvnit fr

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February 26, 1971

John Leisaan

Der Johnt

TMe is to notify you that because your ejBploy*ant with th Unified School Diartriot atorted after Jaauary 1, 1971, ar< not at tma tia iaauiaf you a teaching contract for tht 19711978 eohool year. W will b able to Issue you a teaching contract for the 1971*cheol year on April 15, 1971 pending final eraloatioa and for W are aorry if this iacaayenittcea you in any vay , but ve kznir you UBdaratand the raaaoniag baMad this, Sincerely,

Walter M. Aaaiatant Buperinteodent, Staff Personnel Services

Dace Mr. thmm Tou have been assigned to teach In an tmawwaiea petition *t Washington Park High School, 1901 - Uttv fitnwt, afftive Of January 15, 1971. the principal of this Mh*el is Mf, J Thompson. You may wish to write to him let ftttfch*? or Id oaim arrangements to visit your ffihaai*

to eontwt MI if If jfMf tew cot Maputo* both th* vitWldln t*x fm MJ bo*plUll tis totwraas* f* ! 4 w <md tfttttm th to ^ of lie* iwMKtintoix Also, if you have not completed your phyill xaadLAaUa a of this dttot please contact our office for the proper fana &4 lunrt thli t*k c*r of as soon as pible. our pwfi<mal ttolf ineonly,

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CCl Mr* theeq? Payroll

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ccj J Payroll Peroonel ' J. Clay T. Peterson

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Teacher License Information for State Report Name Last Social Security No. Major subject
>}
t

~3ol\/j First

uj,In. school Ljtttf. wee

Use certification code from your teacher's license: Full Time Months Annual Highest Degree Squivalency Employed Contract Experience Positions College in in Salary 1-4 <s i- H% r-f or In Even Local Total O aoo Ctf o 4J O 410) 01 FM in Dollars Jniversity OPS !*(*! 9-12 K-8 Highest Credential

Grade or Subject Taught

ll

*7

isoo

0 0

PROBATION FORM 11 (FEB. 62)

UNITED STATES DISTRICT COURT FEDERAL PROBATION SYSTEM

AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION

NAME (tax, Pit * i, wdata)
DATE OF BIRTH DATE SIGNED

1 authorize release to the United States Probation Officer all confidential records and information concerning me.

FPI EBO - . 6-6^11%l.9i30