SCHOOL DISTRICT OF HILLSBOROUGH COUNTY APPLICATION

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					              SCHOOL DISTRICT OF HILLSBOROUGH COUNTY
                   APPLICATION CENTER       1202 EAST PALM AVENUE          TAMPA, FLORIDA 33605                 Name: ______________________________________________________
                                              http://apps.sdhc.k12.fl.us                                                    (Last)                           (First)                      (Middle)
                                                                                                                AN EQUAL OPPORTUNITY EMPLOYER – School Board Policy 6.01 ensures equal
                                                                                                                opportunity for all in its personnel policies and practices and does not discriminate on the
                           APPLICATION FOR EMPLOYMENT                                                           basis of race, color, sex, religion, national origin, marital status, disability or age.


APPLICATIONS MUST BE COMPLETE AND RENEWED YEARLY                                                 Transcripts are required as applicable. This application will be considered only if it has been
completed fully and accurately. Offers of employment are subject to proper qualifications and/or certification. School District of Hillsborough County workplaces are drug-free. Employees are
prohibited from engaging in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance. Violation of this prohibition shall result in appropriate disciplinary
action up to and including termination. NOTE: CURRENT AND/OR FORMER EMPLOYEES - DO NOT COMPLETE THIS APPLICATION. INSTEAD, COMPLETE THE APPLICATION UPDATE FORM.

                I AM APPLYING FOR THE FOLLOWING POSITION(S):                                                          I AM APPLYING FOR THE FOLLOWING POSITION(S):

EXECUTIVE, ADMINISTRATIVE, MANAGEMENT - All the positions in this job family                          INSTRUCTIONAL SUPPORT - All the positions in this job family require at least a High
require at least a Master's Degree from an accredited college or university or equivalent             School Diploma/GED Equivalent. Some require additional certification and/or degrees.
responsible related experience.
                                                                                                       Substitute Teacher                 Assistant Teacher, Instructor
 Superintendent                        Operations/Program Area Administrator/Manager                 Classroom Paraprofessional         Child Care Worker
 Organizational Area Senior Executive  Principal, Assistant Principal or Site Administrator          Student Services Paraprofessional  Speech Assistant
INSTRUCTIONAL PROFESSIONAL - All the positions in this family require at least a                      OPERATIONS SUPPORT - All the positions in this job family require at least completion of
Bachelor's Degree from an accredited college or university. (* Bachelor’s or Associate’s              6th grade education or higher. Some require additional certification and/or degrees.
Degree and/or equivalent related experience)
                                                                                                       Student Nutrition Services               Automotive/Equipment Repair & Maintenance
 Classroom Teacher                              School Psychologist                                  Bus Driver                               Custodial, Maintenance, Grounds
 Media Specialist                               Resource Teacher                                     Purchasing and Warehouse                 Skilled and Unskilled Labor
 Guidance Counselor                             Professional Trainer
 Guidance Resource Teacher                      Speech Therapist                                    _____________________________________________________________________________________
  School Social Worker                           Educational Career Specialist *                              Telephone #                                       SS #

TECHNICAL PROFESSIONAL - All the positions in this job family require at least a High                 PERMANENT ADDRESS:
School Diploma/GED Equivalent. Some require additional certification and/or degrees.
                                                                                                      _____________________________________________________________________________________
 Nursing Personnel                              Fiscal, Budget, Purchasing, Risk Analysts                                                 Street/Apt.

 Audiologist                                    Investigator, Security, Safety Specialist           _____________________________________________________________________________________
 Programmer, Network Analyst                    Engineer, Architect, Inspector                               City/State/Zip                                    E-Mail
                                                                                                      TEMPORARY ADDRESS:
 Administrative, Executive Assistants           Benefits, Personnel Specialist
 Auditor, Accountant                            Occupational, Physical Therapist                    _____________________________________________________________________________________
                                                                                                                                            Street/Apt.
CLERICAL SUPPORT - All the positions in this job family require at least a High School                _________________________________________________________
Diploma/GED Equivalent. Some require additional certification and/or degrees.                                   City/State/Zip

 Clerk                                          Customer Service Representative                     Are you a citizen of the United States of America?
 Secretary                                      Receptionist                                                  Yes
 Bookkeeper                                     Registrar                                                      No, but I have a current, valid employment work authorization.
 Data Processor                                 Office Network Computer Specialist                             No, but I have a previous H-1B-Visa that I need to refile.
                                                                                                                 No, I need sponsorship. I do not have employment work authorization.
PERSONAL:

Are you a veteran of the U.S. Military?                           Yes  No
(Complete the Attached Veterans' Preference Form if Applicable.)
Are you in the National Guard or the U.S. Armed Forces Reserves?  National Guard  Reserves  Neither
_________________________________________________________________________________________________________
Have you ever been an employee of the School District of Hillsborough County in any job?              Yes  No
If yes, under what name were you employed? ___________________________________________________
__________________________________________________________________________________________________________
Must your records be withheld from release in accordance with the Public Records Law?            Yes    No
__________________________________________________________________________________________________________
We ask for your ethnicity so we may judge our hiring practices and Equal Employment Opportunity compliance. It WILL NOT be
         .
used in making employment decisions, except as allowed by law.

         American Indian/Alaskan Native               Multi Racial
         Asian Pacific Islander                       None Selected
         Black, Non Hispanic                          None of the Above
         Hispanic                                     White, Non-Hispanic
__________________________________________________________________________________________________________



CERTIFICATION/LICENSURE:

1.      If you have an Educator Certificate or Professional/Technical License, please provide the following information:
        (Please note: Statement of Eligibility is not a teaching certificate.)

        List Certification/License Coverage(s) on your certificate/license:_____________________________________________

        State Issuing Certificate/License: ___________________         Validity Dates: _______________ to __________________
                                                                                          MM/DD/YYYY              MM/DD/YYYY
        Type of Certificate/License:          Temporary        Professional       Other
        Certificate/License Number: ____________________

2.      Has action ever been taken against your certificate by any Education Practices Commission?                      Yes  No
        If yes, attach a copy of any Final Order(s) that was (were) issued.

3.      Have you ever had any professional license (a driver's license is not a professional license) or professional certificate,
        including a teaching certificate, sanctioned by the issuing agency in this or any state? Sanctioned is defined to include
        suspension, revocation; discipline, such as issuance of a reprimand or fine; or, otherwise conditioned, such as placed on
        any restriction or probation.                                                                                   Yes  No
4.      Have you ever resigned, surrendered, or otherwise relinquished a professional license or certificate in this or any state?
                                                                                                                    Yes  No
5.      Is there any action pending in this or any state against a professional license or certificate you hold or held?
                                                                                                                        Yes  No
6.      Is there any action pending in this or any state against an application for a professional license or certificate you have on
        file? (A determination of academic ineligibility is not considered denial of a license or certificate.)          Yes  No
        IF YOU ANSWERED YES TO ANY OF THE QUESTIONS 3 THROUGH 6, PLEASE EXPLAIN THE
        CIRCUMSTANCES ON THE ATTACHED/DOWNLOADED CERTIFICATE/LICENSE ACTION FORM
        AND SEND FORM TO THE APPLICATION CENTER.
CRIMINAL HISTORY:

ATTENTION: PLEASE READ VERY CAREFULLY.
   Under provisions in Florida Statutes 943.0585 and 943.059, the entire arrest record is revealed to
   school districts by the Florida Department of Law Enforcement and the FBI when fingerprints are
   supplied, including "sealed records" and "expunged records." Therefore, you are required to reveal
   such information on the criminal history form.
   Be aware that falsification of records includes omission of information and constitutes grounds for
   dismissal. Conviction of a crime will not necessarily be a bar to employment. Factors such as age at
   the time of the offense, type of offense, remoteness of the offense in time and rehabilitation will be
   taken into account in determining effect on suitability for employment.
Check either “Yes” or “No” next to each question.

   Have you ever been arrested or charged for a criminal offense other than a minor traffic violation?          Yes             No
   NOTE: DUI’s are NOT “minor” traffic violations.


   Is there any criminal charge now pending against you other than a minor traffic violation?                   Yes             No
   NOTE: DUI’s are NOT “minor” traffic violations.


   Are you currently on probation or currently under any imposed requirements for charges other                 Yes             No
   than a minor traffic violation? NOTE: DUI’s are NOT “minor” traffic violations.


If YES to any of the above, download the CRIMINAL RECORD INFORMATION form, complete it, and send it with this
application to the Application Center.


EDUCATIONAL PREPARATION:
                                             Circle the Highest Grade Completed
  General Education                                       College                                     Graduate School
 6 7 8 9 10 11 12                                           1 2 3 4                                      1 2 3 4
                                                                                        Graduated or
       Name                             School Level                       Diploma     Date Received        If Applicable,
          of                                                               or Degree   Degree or Date      Answer Questions
   School Attended                       City, State                         Type       Anticipated             Below
                                                                                         MM/DD/YYYY

                                                                                                        If you did not graduate, do
                          High School   or         Last School Attended                                 you have a GED certificate?
                                                                                                            Yes □        No □
                        ____________________________                                                    If yes, date issued:_________
                                             City, State

                          Business/Trade/Tech         College/University                                Major Subject:
                                                                                                        ________________
                        ____________________________                                                    Minor Subject:
                                             City, State

                          Business/Trade/Tech         College/University                                Major Subject:
                                                                                                        ________________
                        ____________________________                                                    Minor Subject:
                                             City, State

                          Business/Trade/Tech         College/University                                Major Subject:
                                                                                                        ________________
                        ____________________________                                                    Minor Subject:
                                             City, State
WORK EXPERIENCE AND/OR TEACHING EXPERIENCE:
        (List Present/Recent Position First)
(LIST INTERNSHIP/STUDENT TEACHING; DO NOT LIST PRACTICUM)

    Name of Business/School                                                From              To
                                          City, State      Phone                                             Your Title
       and Supervisor                                                   (MM/DD/YYYY)    (MM/DD/YYYY)

 _______________________                                                                                ______________
                                                                                                          Full-time   Part-time

 _______________________                                                                                ______________
                                                                                                          Full-time   Part-time

 _______________________                                                                                ______________
                                                                                                          Full-time   Part-time

 _______________________                                                                                ______________
                                                                                                          Full-time   Part-time

 _______________________                                                                                ______________
                                                                                                          Full-time   Part-time

 _______________________                                                                                ______________
                                                                                                          Full-time   Part-time

 _______________________                                                                                ______________
                                                                                                          Full-time   Part-time


REFERENCES:

List two professional references, including principals (current and/or last) and supervisors. Please provide correct addresses
which are legible and complete.

Employment Outside of Education: Provide the name of at least one immediate supervisor.

Applicants who have never been employed should provide two personal references.


IF YOU ARE A TEACHER APPLICANT:

Experienced Teacher: Provide the name of your most recent principal or immediate supervisor.

Recent Graduate: Provide names of both the directing teacher and the principal of the internship school.

                                                                                                         Area Code and
   Reference’s Name and Position              Name of School/Business         City, State and Zip      Telephone Number

 ____________________________
                  Name

 ______________________________________
                 Position


 ____________________________
                  Name

 ______________________________________
                 Position
                                                                                                       yS




                           School District of Hillsborough County




Mail to:

Providence C. Velasco Student Services Center
ATTN: APPLICATION CENTER
1202 East Palm Avenue
Tampa, Florida 33605

I, ________________________________, certify that the answers and statements I have provided to the
questions on the employment application are true and correct without any falsifications, omissions, or
misleading statements of any kind whatsoever. I agree that the District School Board of Hillsborough
County shall not be held liable in any respect if I am not employed or if my employment is terminated
because of false or misleading statements or answers or omissions made by me in this application.

         Signature of Applicant:               ______________________________________

         Printed Name:                         ______________________________________

         Social Security Number:               ______________________________________

      Date Signed:            ______________________________________
____________________________________________________________________________________
Please remember to attach any other required documents. If at any time you wish to view your
application, please visit our website and login to the application section using your User Name and
Password. (If you did not apply online, you may still login – but first you will need to retrieve your
assigned User Name and Password. To do so, go to the Human Resources website
(http://apps.sdhc.k12.fl.us/hrdiv/), click on APPLICATION FOR EMPLOYMENT (on the left side of the
Human Resources home page) * find the area in the center of the page that says: “DO YOU NEED YOUR
USER NAME AND PASSWORD?” and follow the directions below it to retrieve your USER NAME and
PASSWORD * Return to the Login page to login to the Application for Employment. Once logged-in, you
may see your current application status, and links to any documents you may need to complete and send to
Application Center.)
YOUR APPLICATION MUST BE SUBMITTED WITH ALL REQUIRED DOCUMENTS.
After signing and dating this signature form, please make a copy for your records and mail the original to
the address at the top of this signature form.
                                       AN EQUAL OPPORTUNITY EMPLOYER
School Board Policy 6.01 ensures equal opportunity for all in its personnel policies and practices and does not discriminate on the
basis of race, color, sex, religion, national origin, marital status, disability, or age.

           Raymond O. Shelton School Administrative Center • 901 East Kennedy Boulevard • Tampa, Florida 33602-3507
           Office: Phone: 813-272-4148 • SUNCOM 547-4148 • School District Information 813-272-4000 • Fax: 813-272-4686
                                P.O. Box 3408 • Tampa, FL 33601-3408 • Web Site: http://apps.sdhc.k12.fl.us

				
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