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                                                                        

Type of employment:  q Full-time q  Part-time  q  Summer only 

Date you can begin work                                                                                                         

Have you been employed by                                                 ISD in the past? q  Yes q  No 

If you answered yes, provide dates of employment                                                                 

Special Skills

List specific skills, software proficiency, and any machines or equipment you can operate. Include number of years of experience. 

1.                                                                        4.                                                                    

2.                                                                        5.                                                                    

3.                                                                        6.                                                                                                                                      

Work Experience

Please provide a complete list of all positions you have held in the past 10 years. List the most recent first. Attach additional sheets if necessary (bus driver applicants, see adden­dum). 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

Work Experience

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

Education/Training

List the highest level of education attained: _____________________________________

 Licenses and certificates granted ______________________________________________

_________________________________________________________________________

Name and location of schools attended

Course of study and major/minor

Diploma, degree, certificate, or license granted

Year graduated

(College only)

General Information

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

q Yes q 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)? q Yes q 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 sub­sequent employment.

I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal 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. This application shall be considered active for _____ months. If you have not received a response during this time period, you may reapply or reactivate your application.