Fillable A lication Process or Su lemental Salar (Cabot Public Schools)

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A lication Process or Su lemental Salar (Cabot Public Schools)

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A
pp
lication Process
f
or Su
p
p
lemental Salar
y
Application Procedure:
1. Complete the “Supplemental Salary Application”. It is located at www.cabotschools.org, under
“employee forms”.
2. Teacher applications will be submitted to the building administration for signature.
3. The building administrator will sign and send the “Supplemental Salary Application” to the
Director of Personnel, by October 1
st
.
Review Procedure:
1. The Supplemental Salary Committee will meet after the October 1
st
deadline to review applications.
2. The SSC will send a recommendation to the Personnel Policy Committee for review.
3. A joint recommendation from the SSC and PPC will be sent to the superintendent.
4. The superintendent will submit the recommendation to the school board.
5. The SSC will keep all applications submitted on file for one (1) year.
Su
pp
lemental Salar
y
A
lication
Title of Position ___________________________________________________________________________
School __________________________________________ District Wide ________________________
Person Filling/Requesting The Position ________________________________________________________
Current Pay ______________________________ Requested Pay _________________________________
Number of Hours ________________________________ (must be itemized on survey sheet)
Supervision of: _____________ Students Number of students ________________________
_____________ Adults Number of adults __________________________
Duties Based On: ________ Personal choice for an additional activity
________ Administrative request for an additional duty
Brief job description (3 sentences)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Signature __________________________________________ Date _______________________________
---------------------------------------------------------------------------------------------------------------------
Building Administrator:
_____ approved _____ approved with changes as noted _____ denied
Signature ____________________________________
Supplemental Salary Committee:
_____ survey completed _____ job description
Signature ____________________________________
Date _______________________________
_________________ index assigned
Date _______________________________
Personnel Policy Committee:
_____ approved ______ returned to Supplemental Committee ______ denied
Signature ____________________________________ Date _______________________________
Page 1
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Please answer the following questions, make a copy for yourself, and give the original to your building
administrator.
Name __________________________________________________________
School _________________________________________________________
Organization or Activity _________________________________________________
1. Is this organization associated with any regional, state, or national organization?
Yes (please specify) _________________________________________
No
2. What is the purpose of this organization/activity? ______________________________________
3. Is this organization/activity:
a duty assigned by an administrator?
a duty developed by you or other teachers?
a duty that is part of your job description?
a duty for which you applied?
any duty not mentioned above?
4. Identify the supervisor(s) to whom you are required to report your activities: ________________
5. Who would be responsible for evaluating this program? ________________________________
6. Current amount of compensation received for your work with this organization/activity: _______
7. What amount would you consider to be a reasonable/equitable compensation? _______________
8. Does this organization have a constitution of written operating procedure?
Yes (attach a copy of existing documents)
No
9. In 100 or less list / describe your responsibilities. You are limited to the space provided.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Page 2
Name ____________________
School ___________________
10. List the events/activities of this organization/activity.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
11. Would you consider this organization/activity to be:
academic
non-academic (extra-curricular)
part of an elective course available to students
other (specify) _________________________________________________________________
12. On average, how many students are actively involved in the organization/activity? _________________
13. What kind of financial obligations are associated with this organization/activity?
local, regional, state, national dues
conference/competition registration fees (please specify) ________________________________
______________________________________________________________________________
other (please specify) ____________________________________________________________
______________________________________________________________________________
does not apply
14. What is the source of funding for your organization/activity?
student dues
school budget
money making activities (please specify) ____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
15. In your opinion, should work with this organization/activity be rewarded with a stipend?
a stipend?
period during the workday?
Other (specify) ________________________________________________________________
16. Does your daily schedule include a period devoted to this organization/activity?
Yes
No
Page 3
Name ____________________
School ___________________
17. Estimate the time you spend being actively involved in this organization/activity.
Before School:
15-30 minutes per day
30-60 minutes per day
15-30 minutes per week
30-60 minutes per week
15-30 minutes per month
30-60 minutes per month
List your responsibilities: ____________________________
_________________________________________________
_________________________________________________
_________________________________________________
After School:
15-30 minutes per day
30-60 minutes per day
15-30 minutes per week
30-60 minutes per week
15-30 minutes per month
30-60 minutes per month
List your responsibilities: ____________________________
_________________________________________________
_________________________________________________
_________________________________________________
During the regular school day, e.g., lunch, preparation period, etc.
15-30 minutes per day
30-60 minutes per day
15-30 minutes per week
30-60 minutes per week
15-30 minutes per month
30-60 minutes per month
List your responsibilities: ____________________________
_________________________________________________
_________________________________________________
_________________________________________________
Page 4
Weekends:
15-30 minutes per week
30-60 minutes per week
15-30 minutes per month
30-60 minutes per month
List your responsibilities: ____________________________
_________________________________________________
_________________________________________________
_________________________________________________
Summer
Describe any summer time spent on activities associated with this responsibility. Provide practice
schedules, conference programs, etc. when available. ______________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
18. Describe any positive publicity that your organization/activity has generated for the Cabot Public School
District. (Attach newspaper articles, etc.) __________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
19. What issues that are pertinent to your duties have not been addressed in this survey?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Page 5
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A lication Process or Su lemental Salar (Cabot Public Schools)

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Completed 15 June 2021

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