Post Office Box 408
(409) 746 2731
We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital or veteran status, the presence of a medical condition or handicap that is not job related or any other legally protected status.
Date of Application Social
Security #
Name
Last First MI
Current Address
Street/Box City State Zip
Other address where
you may be reached
Work Phone # Home
Phone #
Name used on records
if different from present name
(To be used for
reference checks)
Position for which
you are applying
Credentials included
with application:
q Resume
q All teaching & professional certificates (front &
back, if appropriate)
q All transcripts showing degrees
Date Available
Former Deweyville ISD
Employee: Yes No
If yes, give dates of
employment:
Schools Attended: List all applicable information.
Name of School and Location |
Course of Study Major/Minor Fields |
Diploma, Degree or Certificate |
Year Graduated College Only |
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Type of
certificate held now
q None
q Valid
q Valid other
state
q Emergency (
q
q
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Areas of specialization
q Administrator All level art Vocational
(specify):
q Superintendent All level health & PE
q Principal All level music Nurse
q Mid-Management
Administrator Librarian Visiting teacher
q Elementary Counselor Supervisor
q Elementary
& kindergarten Special Education (specify): Others (specify):
q Secondary
(junior & senior high
List teaching experience beginning with most recent years.
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Name of
School & Location |
Type of
Assignment |
Dates Taught |
Reason for
leaving |
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Total
creditable years (Full-time teaching in college, public school
or an accredited private school is creditable.)
Please provide a complete listing of all other jobs or administrative positions you have held in the past ten (10) years.
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School District/Firm Name |
Position/Title |
Dates Employed |
Reason for Leaving |
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Omit
references to organizations that would reveal race, age, ethnic origin or religious
persuasion.
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Publications/articles
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Seminars/workshops conducted
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Other related professional activities
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Are you aware of any reasons you would not be able to
perform the duties of the position for which you are applying? Yes No If yes, please explain
·
Do you have a relative who is a member of the Deweyville ISD
Board of Education?
Yes No If yes,
please give the name of relative and relationship:
·
Have you ever been convicted of 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 explain:
(Conviction of a felony 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.)
Please list below
references who may be contacted regarding your work history. Include all managers/supervisors at the last
two employing organizations who evaluated and/or supervised your performance.
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Full Name of Reference |
School District Firm Name |
Mailing Address |
Position/Title |
Area Code & Phone Number |
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Please make a statement in your
own handwriting concerning your reasons for desiring a position with the
Deweyville ISD. (Use backside of this
page if necessary.)
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/or all information concerning my previous employment and
any pertinent information they may have, personal or otherwise, and release all
parties from liability for any damage that may result from furnishing same to
you.
I understand that the district is
required by Texas Education Code §21.917 to obtain criminal history record
information on applicants for employment.
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 of time not to exceed 750
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.
Signature of Applicant Date