Sample Employment Application for Professional Personnel

MOTLEY COUNTY INDEPENDENT SCHOOL DISTRICT EMPLOYMENT APPLICATION FOR PROFESSIONAL PERSONNEL An Equal Opportunity Employer*

Date of application ______Social Security ______-____-______

Name a

t Last First Middle initial a Current address D

l Street/Box City State ZIP Code a

n Other address where you may be reached o

s Home phone Cell phone Other phone r

e Other name that may appear on records P State of birth ______TX Drivers License #______(Used for certification, reference, and criminal history record checks)

List the position(s) for which you are applying Credentials included with application: a

t  Résumé a D  All teaching and professional certificates or licenses n o i t

i  All transcripts showing degrees s o

P Date you can begin work ______Have you been employed by______ISD in the past?  Yes  No If you answered yes, provide dates of employment______

g Year

n Diploma, degree, i Name and location of schools Course of study and

n certificate, or license graduated i

a attended major/minor (College only)

r granted T / n o i t a c u d E

Certificates or Licenses Currently Held:  None e r  Valid Texas u s  Valid Other State n e  Texas One-Year (out-of-state/country): Expiration date:______c i

L  Other: ______/ n o Category/Level(s) of Certification: ______i t a

c Areas of Specialization/Supplemental Certificates/Endorsements (as listed on certification): i f i t r e C

n List teaching experience beginning with most recent years. e i r e

p Name and location Name and location of x of school school E g n i Type of assignment Type of assignment h c a e T Dates taught Dates taught

Principal’s name Principal’s name and and phone phone

Reason for leaving Reason for leaving

Name and location Name and location of of school school

Type of assignment Type of assignment

Dates taught Dates taught

Principal’s name Principal’s name and and phone phone

Copyright 8/1/2007 Texas Association of School Boards. All rights reserved. MOTLEY COUNTY INDEPENDENT SCHOOL DISTRICT EMPLOYMENT APPLICATION FOR PROFESSIONAL PERSONNEL e c Please provide a list of all other jobs or administrative positions you have held in the past 10 n

e years. Attach additional sheets if necessary. Attach résumé if available. i r e

p Employer name and Employer name and x location location E k r o Position/title held Position/title held W r e h t Dates employed Dates employed O

Supervisor’s name Supervisor’s name and phone and phone

Employer name and Employer name and location location

Position/title held Position/title held

Dates employed Dates employed

Supervisor’s name Supervisor’s name and phone and phone

Reason for leaving Reason for leaving s e c Please list references the district can contact regarding your work history. n e r e f Full name of School district/ Mailing Area code/ e Position/title

R reference firm name address phone number

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:

n o i t

a Have you ever been convicted of, pled guilty or no contest (nolo contendre) to, or received m

r probation, suspension, or deferred adjudication for a felony or any offense involving moral o f turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a n I

l minor)?  Yes  No a r e

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

(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.)

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 n o

i sonal or otherwise, and release all such parties from liability for any damage that may result t

a from furnishing the same to you. c i f i r

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

Signature Date

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

*Applicants for all positions are considered without regard to race, color, national origin, religion, sex, marital status, veteran or military status, disability, or any other legally protected status

The district Title IX Coordinator is William Cochran, Superintendent.