An Equal Opportunity Employer
Date of Application Social Security #

Last Name First Name MI

Current Mailing Address
Street/PO Box City State Zip

Work Phone # Home Phone #

Position for which you are applying

Type of Employment: Fulltime Part-time Summer Only

Date Available

Former Deweyville ISD Employee: Yes No
If yes, give dates of employment:

Check highest level attained.
Not high school graduate ( last grade completed .)
High school graduate GED less than 2-yr. college
Two or more years college Bachelor’s degree
Master’s degree Other training or education

Licenses/certifications held


Schools Attended: List all applicable information.
Name of School and Course of Study Diploma, Degree Year Graduated
Location Major/Minor Fields Or Certificate College Only

Please provide a complete listing of all other jobs or positions you have held in the past 10 years. List most recent first. Attach additional sheets if necessary. (Bus driver applicants, see Addendum.)

Employer & Location Position/Title Dates Employed Reason for leaving

List specific skills and/or any machines or equipment you can operate. Include typing speed and number of year’s experience.

1. 4.

2. 5.

3. 6.

? 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.
Full Name of Reference School District
Or Firm Name Mailing Address Position/Title Area Code & Phone Number

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