<p> BIG SANDY ISD PO BOX 598 BIG SANDY, TEXAS 75755 An Equal Opportunity Employer*</p><p>Date of application </p><p> a Name t</p><p> a Last First Middle initial D</p><p>Current address l</p><p> a Street/Box City State ZIP Code n</p><p> o Other address where you may be reached s</p><p> r Home phone Cell phone Other phone e</p><p>P Other name that may appear on records (Used for certification, reference, and criminal history record checks)</p><p>List the position(s) for which you are applying Credentials included with application: a</p><p> t Résumé a D All teaching and professional certificates or licenses n o i t</p><p> i All transcripts showing degrees s o</p><p>P Date you can begin work Have you been employed by Big Sandy ISD in the past? Yes No If you answered yes, provide dates of employment </p><p> g Year</p><p> n Diploma, degree, i Name and location of schools Course of study and</p><p> n certificate, or license graduated i</p><p> a attended major/minor (College only)</p><p> r granted T / n o i t a c u d</p><p>E </p><p>BIG SANDY ISD PO BOX 598 BIG SANDY, TEXAS 75755 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 Other: L / n</p><p> o Category/Level(s) of Certification: i t a</p><p> c Areas of Specialization/Supplemental Certificates/Endorsements (as listed on certification): i f i t r e</p><p>C </p><p> e c</p><p> n List teaching experience beginning with most recent years. e i r e</p><p> p Name and location Name and location of</p><p> x of school school E</p><p> g n i Type of assignment Type of assignment h c a e T Dates taught Dates taught </p><p>Principal’s name Principal’s name and</p><p> and phone phone</p><p>Reason for leaving Reason for leaving </p><p>Name and location Name and location of</p><p> of school school</p><p>Type of assignment Type of assignment </p><p>Dates taught Dates taught </p><p>Principal’s name Principal’s name and</p><p> and phone phone</p><p>Reason for leaving Reason for leaving BIG SANDY ISD PO BOX 598 BIG SANDY, TEXAS 75755 e c Please provide a list of all other jobs or administrative positions you have held in the past 10 n</p><p> e years. Attach additional sheets if necessary. Attach résumé if available. i r e</p><p> 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</p><p>Supervisor’s name Supervisor’s name </p><p> and phone and phone</p><p>Reason for leaving Reason for leaving </p><p>Employer name and Employer name and </p><p> location location</p><p>Position/title held Position/title held </p><p>Dates employed Dates employed </p><p>Supervisor’s name Supervisor’s name </p><p> and phone and phone</p><p>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</p><p>R reference firm name address phone number</p><p>BIG SANDY ISD PO BOX 598 BIG SANDY, TEXAS 75755 Do you have a relative who serves on the Board of Education or is an employee of Big Sandy ISD?</p><p> n Yes No If yes, please provide the relative’s name and relationship: 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</p><p> n turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a I</p><p> l minor)? Yes No a r e n</p><p> e If yes, please state where, when, and the nature of the offense G (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.)</p><p>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.</p><p>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</p><p> i sonal or otherwise, and release all such parties from liability for any damage that may result t</p><p> a from furnishing the same to you. c i f i r</p><p> e I understand that the district is required by Texas Education Code to review criminal history V of applicants.</p><p>Signature Date</p><p>This application becomes the property of the district. The district reserves the right to accept or reject it.</p><p>*Applicants for all positions are considered without regard to race, color, sex (including pregnancy), national origin, religion, age, disability, genetic information, veteran or military status, or any other legally protected status.</p><p>The district Title IX Coordinator is Superintendent PO Box 598 Big Sandy, Texas 75755 (903-636-5318)</p>