Employment Application for Service & Support Personnel

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.

An Equal Opportunity Employer

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 #

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 (Circle last grade completed.) 1 2 3 4 5 6 7 8 9 10 11

___ 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

Employment Application for Service & Support Personnel

An Equal Opportunity Employer

Name of School and