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)

Assignment Preference

Please list the days you are available to substitute and your assignment preferences. 

Day(s) of week   q Every day

                            q Monday  q Tuesday     q Wednesday    q Thursday  q Friday

Assignment         q Any assignment

       q Elementary  q Intermediate  q Secondary      q Special Education

Preferred campuses                                                                                                                                                                                                                                                              

Are you receiving Texas Teacher Retirement (TRS) benefits? q Yes q No

(The amount of time that an individual receiving TRS benefits may be employed without affecting benefits is governed by TRS rules and laws.)

Position Data

Credentials included with application:

 q Résumé                       

 q All teaching and professional certificates or licenses

 q All transcripts showing degrees

Have you been employed by_________________________ISD in the past? q Yes q No

If you answered yes, provide dates of employment______________________

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)

Certification

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

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 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 record information of substitute teachers.

          Signature                                                                         Date

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