Independent Contractors Texas by bzr17786

VIEWS: 7 PAGES: 5

More Info
									Sunnyvale Independent School District                                                                                        Office Use Only
417 E. Tripp Road                                                                                Date Received:
Sunnyvale, TX 75182                                                                              Date Renewed:
972-226-5974 ph.                      972-226-6882 fax                                           Actual Interview Date(s):

                                                   Employment Application for Substitute Employment
           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, disability, or any other legally protected status.
                                                             An Equal Opportunity Employer

                           Date of Application                                           Social Security No.
  Personal Data




                           Name
                                                        Last                                     First                                               Middle Initial

                           Current Address
                                                               Street/Box                                 City                               State             Zip Code

                           Other address where you may be reached

                           Work Phone No.                                                Home Phone No.

                           Name used on records if different from present name
                                                                                                                 (to be used for reference checks)
  Position Data




                           Type of Substitute Position seeking:                                  Grade Levels Willing to Substitute for:
                                  Classroom Teacher            Cafeteria                                    Kindergarten                                  Grades 6-8
                                  Librarian                    Secretarial                                  Grades 1-5                                    Grades 9-12
                                  Teacher's Aide               Bus Driver                                   Special Classes (P.E., Art, Music, etc.)
                           Days of the Week Available:
                                  Monday                                Wednesday                           Friday
                                  Tuesday                               Thursday
                           Check highest level attained
                                  Not high school graduate (circle last grade completed)          6          7           8         9       10        11         12
                                  High School Graduate                                   GED
                                  Less than two years in college                         Two or more years of college
                                  Bachelor's degree                                      Master's degree
  Education / Training




                                  Teacher Certificate


                           Schools Attended: List all applicable information
                                                                    Course of Study                      Diploma, Degree                              Dates Attended
                              Name of School and Address
                                                                      Major/Minor Fields                            or Certification                  Year Graduated




                         Sunnyvale I.S.D                                                                                                                 Page 1
Certifications             Other Training or education:
 & Licenses

                           Other Licenses / Certifications held:




                           Please provide a complete listing of all jobs or positions you have held in the past 10 years. List the most
                           recent first. Attach additional sheets if necessary.
                                 Dates                                                                          Salary or
                                                             Employer                  Job Position / Title                       Reason For Leaving
                                                                                                                 Wages
                             From          To
   Work Experience




                           Do you have a relative who is a member of the Sunnyvale I.S.D. Board of Education?                     Yes         No

                           If yes, please give name of relative and relationship:
   General Information




                           Do you speak a foreign language?               Yes             No          If yes, what language(s)?

                           Are you a U.S. Citizen or a legal immigrant?          Yes             No

                           Have you ever been convicted of, pled guilty or no contest (nolo contendre) to, or received probation, suspension,
                           or deferred adjudication for a felony or any 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:




                           (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.)




                         Sunnyvale I.S.D                                                                                                  Page 2
                 Please list references who may be contacted regarding your work history. Include supervisors at
                 the employing organizations who have evaluated or supervised your performance at your last two
                 employers.
                                             School District/Firm Name
                  Full Name of Reference                                                        Position/Title       Area Code/Phone
                                                                 Mailing Address
                                                                                                                  (WK)

                                                                                                                   (HM)
References




                                                                                                                  (WK)

                                                                                                                   (HM)

                                                                                                                  (WK)

                                                                                                                   (HM)

                                                                                                                  (WK)

                                                                                                                   (HM)

                                                                                                                  (WK)

                                                                                                                   (HM)

                 I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and
                 understanding that any deliberate falsification, misrepresentation, 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 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
                 damage 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.
                 This application becomes the property of the district. The district reserves the right to accept or reject it. This
Verification




                 application shall be considered active for a period of time not to exceed two years. Any applicant wishing to be
                 considered for employment beyond this time period my inquire as to whether or not applications are being accepted at
                 that time.




                 Signature of Applicant                                                         Date



                 Return to:      School Administration
                                 Sunnyvale I.S.D.
                                 417 E. Tripp Road
                                 Sunnyvale, TX 75182
                                 972-226-5974




               Sunnyvale I.S.D                                                                                             Page 3
              Criminal History Record Information Request

                                                 Confidential*
  The Sunnyvale Independent School District is required by Texas Education Code Chapter
  22, Subchapter C to review the criminal history of applicants, employees, independent
  contractors, student teachers, and certain volunteers. The information requested below is
  necessary to obtain criminal history record information.

  Please Print

  Name
                               Last                                  First                          Middle


  Social Security Number                                             Date of birth


  Driver's License
                                            State and Number


  Mailing Address
                                        Street                               City           State            Zip



  Sex:             Male               Female


  I understand that the information I am providing about age, sex, and ethnicity will not be
  used to determine eligibility for employment but will be used solely for the purpose of
  obtaining criminal history record information.




  Signature



  Date




  * This form will be removed from the application and filed separately in the HR office.




Sunnyvale I.S.D                                                                                               Page 4
Sunnyvale I.S.D   Page 5

								
To top