Date of application _________________

Personal Data

Name                                                                                                                                        

            Last                                            First                                          Middle initial

Current address                                                                                                                        

                          Street/Box                       City                                   State                    ZIP Code

Other address where you may be reached                                                                               

Home phone                              Cell phone                               Other phone                           

Other name that may appear on records                                                                                   

      (Used for certification, reference, and criminal history record checks)

Position Data

List the position(s) for which you are applying                                                                     

Credentials included with application:

 Résumé                       

 All teaching and professional certificates or licenses

 All transcripts showing degrees

  Date you can begin work __________________

Have you been employed by_________________________ISD in the past?   Yes   No

If you answered yes, provide dates of employment______________________

Education/Training

Name and location of schools attended

Course of study and major/minor

Diploma, degree, certificate, or license granted

Year graduated

(College only)

Certification/Licensure

Certificates or Licenses Currently Held:

1. None
2. Valid Texas
3. Valid Other State                                           
4. Texas One-Year (out-of-state/country): Expiration date:______________________
5. Other: ______________________________

Category/Level(s) of Certification:                                              _____________________

Areas of Specialization/Supplemental Certificates/Endorsements (as listed on certification):

Teaching Experience

List teaching experience beginning with most recent years.

Name and location of school

Name and location of school

Type of assignment

Type of assignment

Dates taught

Dates taught

Principal’s name and phone

Principal’s name and phone

Reason for leaving

Reason for leaving

Name and location of school

Name and location of school

Type of assignment

Type of assignment

Dates taught

Dates taught

Principal’s name and phone

Principal’s name and phone

Reason for leaving

Reason for leaving

Other Work Experience

Please provide a list of all other jobs or administrative positions you have held in the past 10 years. Attach additional sheets if necessary. Attach résumé if available.

Employer name and location

Employer name and location

Position/title held

Position/title held

Dates employed

Dates employed

Supervisor’s name and phone

Supervisor’s name and phone

Reason for leaving

Reason for leaving

Employer name and location

Employer name and location

Position/title held

Position/title held

Dates employed

Dates employed

Supervisor’s name and phone

Supervisor’s name and phone

Reason for leaving

Reason for leaving

References

Please list references the district can contact regarding your work history.

Full name of reference

School district/ firm name

Mailing address

Position/title

Area code/ phone number

General Information

Do you have a relative who serves on the Board of Education or is an employee of ___________________ ISD?

 Yes  No  If yes, please provide the relative’s name and relationship:                          

Have you ever been convicted of, pled guilty or no contest (nolo contendre) to, or received probation, suspension, or deferred adjudication for a felony or any offense involving moral turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a minor)? 

               Yes    No

If yes, please state where, when, and the nature of the offense                                           

(A felony conviction is not an automatic bar to employment. The district will consider the nature, date, and relationship between the offense and the position for which you are applying.)

Verification

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application or dismissal from sub sequent employment.

I authorize the references listed on the previous page to give you any and all information concerning my previous employment and any pertinent information they may have, per sonal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.

I understand that the district is required by Texas Education Code to review criminal history of applicants.

                            Signature                                                                         Date

This application becomes the property of the district. The district reserves the right to accept or reject it.