TIOGA INDEPENDENT SCHOOL DISTRICT

POST OFFICE BOX 159

TIOGA, TEXAS 76271

EMPLOYMENT APPLICATION FOR PROFESSIONAL PERSONNEL

We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital status, veteran or military status, the presence of a medical condition, disability, or any other legally protected status.

An Equal Opportunity Employer

Personnel Data

Date of application___________________________________ Social Security number_______________________

Name_________________________________________________________________________________

Last First Middle Initial

Current Address_______________________________________________________________________________

Street/Box City State Zip Code

Other address where you may be reached_____________________________________________________

Work phone______________________________ Home phone___________________________________

Other name that may appear on records______________________________________________________

(Used only for reference checks)

Position Data

List the position(s) you are applying for______________________________________________________

Credentials included with application

_____ Resume

_____ All teaching and professional certificates or licenses

_____ All transcripts showing degrees

Date you can begin work_________________________

Have you been employed by Tioga 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 held	Year graduated (College only)

Certification

Certificate or license currently held:

_____ None

_____ Valid Texas

_____ Valid Other State

_____ Texas Emergency

_____ Texas One-Year:Expires_______________

_____ Texas Temporary Administrative:Expires_______________

Areas of Specialization:

_____Administrator	_____All-Level Art	_____Vocational (specify)
_____Superintendent	_____All-Level Health and PE	____________________
_____Principal	_____All-Level Music	_____Nurse
_____Mid-management Administrator	_____Librarian	_____Visiting Teacher
_____Elementary	_____Counselor	_____Supervisor
_____Elementary and Kindergarten	_____Special Education (specify)	_____Other (specify)
_____Secondary (Jr./Sr. High)	_________________________	_________________

Teaching Experience

List teaching experience beginning with most recent years.

Name and location of school	Type of assignment	Dates taught	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 resume if available.

School district/firm name	Position/title	Dates employed	Reason for leaving

Professional Data

Please list relevant professional activities. Omit references to organizations that would reveal race, age, ethnic origin, or religion.

Papers/articles published_________________________________________________________________________

_____________________________________________________________________________________

Seminars/workshops conducted____________________________________________________________________

_____________________________________________________________________________________

Other related professional activities_________________________________________________________________

_____________________________________________________________________________________

General Information

Do you have a relative who serves on the Tioga ISD Board of Education?

_____Yes _____No If yes, please provide the relative’s name and relationship: __________________________________________________________________

Have you ever been convicted of or plead guilty or no contest (nolo contendre) to a felony or 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; indicate whether the charges were dismissed as a condition of probation, suspension, or deferred adjudication:

___________________________________________________________________________________________________________________________________

(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.)

References

Please list references the district can contact regarding your work history. Please include all managers and supervisors who evaluated or supervised your performance at your last two employers.

Full name of reference	School district/firm name	Mailing address	Position/title	Area code/phone number

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 on the previous page 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 damages that may result from furnishing the same to you.

I understand that the district is authorized by Texas Education Code 22.083 to obtain criminal history record information on applicants the district intends to employ.

_______________________________________________________________________

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 a period not to exceed 365 days. Any applicant wishing to be considered for employment beyond this time period may inquire as to whether or not applications are being accepted at that time.

________________________________________________________________

CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK

IN COMPLIANCE WITH THE FCRA (FAIR CREDIT REPORTING ACT)

____________________________________________________________________________________

Last Name First Name Middle Initial

____________________________________________________________________________________

Maiden and/or Other Names Used

____________________________________________________________________________________

City** County** State**

_______________/__________/19_________ __________-__________-________________

Date of Birth Social Security Number

I, ______________________________, am an applicant for employment with the Tioga ISD and have been advised that as a part of the application process, the district conducts a criminal history background check. I do hereby consent to the district use of any information provided during the application process in performing the criminal history check.

The district has informed me that I have the right to review and challenge any negative information that would adversely impact a decision to offer employment. In addition, I have been informed that I will have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established within the sole discretion of the district. Under the Fair Credit Reporting Act, I have been advised that upon request I will be provided the name, address and telephone number of the reporting agency as well as the nature, substance and source of all information.

The following are my responses to questions about my criminal record history (if any) with descriptions to any question with a YES answer:

1. Have you ever been convicted or plead guilty before a court of any federal, state, or municipal criminal offense? (Excluding minor traffic violations) _____Yes _____No

If YES, Please provide an explanation below:

___________________________________________________________________________________________________________________________________

2. Have you ever received deferred adjudication or similar disposition for any federal, sate or municipal criminal offense? _____Yes _____No

If YES, Please provide an explanation below:

___________________________________________________________________________________________________________________________________

3. Have you ever received probation or community supervision for any federal, state or municipal criminal offense? _____Yes _____No

___________________________________________________________________________________________________________________________________

4. Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States? _____Yes _____No

If YES, Please provide an explanation below:

___________________________________________________________________________________________________________________________________

THIS SECTION IS TO BE USED TO LIST ALL COUNTIES AND STATES OF RESIDENCE SINCE AGE 18 OR HIGH SCHOOL GRADUATION.YOU MUST BE SPECIFIC ABOUT DATES OF RESIDENCE.

CITY/TOWN	COUNTY	STATE	DATES FROM	TO

I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS AUTHORIZATION IS TRUE, CORRECT AND COMPLETE.I UNDERSTAND THAT IF ANY INFORMATION PROVES TO BE INCORRECT OR INCOMPLETE THAT GROUNDS FOR THE CANCELING OF ANY AND ALL OFFERS OF EMPLOYMENT WILL EXIST AND MAY BE USED AT THE DISCRETION OF THE DISTRICT.

Signed this______________________________day of____________________ , 20__________

APPLICANT (Print Name)_______________________________________________________

APPLICANT’S SIGNATURE_____________________________________________________