DAYTON CONSOLIDATED SCHOOL Staff Employment Information (Please Print) Name: Address:

Position:

Teacher

Ed Tech

Admin. Asst. Full Time

Part Time

Current Annual Salary:

Custodian

Other: Degree Level:

$

Salary Step:

Non-Teacher Position Hourly Rate:

Intended Health Insurance Coverage for 2014-2015 School Year: Single Family Dental Insurance:

Adult w/child

2-Person

Cash in Lieu Program (if applicable) Yes

RSU23 Life Insurance Participation:

No Yes

No

Professional Course Reimbursement (for budgeting purpose only): Do you plan to take courses in 2014-2015?

Yes

No

If yes, aniticipated credit hours?

Employee Signature

Date

$

Staff Employment Info.pdf

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