EMPLOYMENT APPLICATION FOR PROFESSIONAL PERSONNEL

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1 Superintendent s Office Middle School (936) (936) (936) fax (936) fax Elementary School High School (936) (936) (936) fax (936) fax EMPLOYMENT APPLICATION FOR PROFESSIONAL PERSONNEL Personal Data: Last First Middle Date of Application: Social Security #: - - Street/box city state zip Work phone #: Home phone #: Name used on records if different from present name (to be used for reference checks): _ Position Data: Position for which you are applying: Credentials included with application: Date available: Former Alto ISD employee? yes Resume All teaching and professional certificates All transcripts showing degrees no If yes, give dates of employment:

2 Education/Training: Schools Attended: List all applicable information. Name of School: Address: Course of Study (Major/Minor): Dates Attended: Diploma/Degree/Certificate: Name of School: Address: Course of Study (Major/Minor): Dates Attended: Diploma/Degree/Certificate: Name of School: Address: Course of Study (Major/Minor): Dates Attended: Diploma/Degree/Certificate: Certification: *Type of certificate now held: None Valid Texas Valid other state: Emergency (Texas) Texas one-year certificate: Expiration date: Texas temporary administrative: Expiration date: *Areas of specialization: Administrator All level art Superintendent All level health/pe Principal All level music Mid-Management Admin. Librarian Elementary Counselor Elementary & Kindergarten Nurse Secondary (Jr/Sr High) Visiting teacher Supervisor Vocational (specify) Special Education (specify) Other (specify) *Have you ever had a non-renewal or been asked to resign? yes no

3 Teaching Experience: Total creditable years (Full-time teaching in college, public school or in an accredited private school is creditable.) Other Work Experience: Please provide a complete listing of all other jobs or administrative positions you have held in the past ten (10) years. Attach additional sheets if necessary. Please attach a resume, if available. School District/Firm Name: Position/Title: Dates: School District/Firm Name: Position/Title: Dates:

4 References: Please list references the school district can contact regarding your work history.

5 Personal Statement: Please make a statement in your own handwriting concerning your reasons for desiring a position with the Alto Independent School District. (Please use additional sheets of paper if necessary.)

6 NON DISCRIMINATION POLICY Alto Independent School District is required by Title IX of the Education Amendments of 1972 and by Section 504 of the Vocational Rehabilitation Act of 1973 not to discriminate on the basis of an individual s race, color, handicap, religion, sex, national origin, or age in the educational program of activities which it operates, or to employment and admission thereto. Alto Independent School District will operate each educational program in compliance with the requirements and exemptions as provided in these acts. Verification: I hereby affirm that all information provided in this application is true and accurate to be best of my knowledge. I understand that, if employed, any falsified information may be considered sufficient cause for dismissal. Furthermore, this application becomes the property of the district which reserves the right to accept or reject it. Signature Date I hereby authorize the district to obtain information from any law enforcement agency, including a police department, the Department of Public Safety, or the Texas Department of Corrections, that relates to employment with the district. Signature Date

7 ALTO INDEPENDENT SCHOOL DISTRICT ADDENDUM TO APPLICATION The Alto Independent School District is required by state law to obtain criminal history record information on all applicants for employment with the district (TEXAS EDUCATION CODE SECTION ). I understand the information set forth below will be used by the district solely for the purpose of obtaining criminal history record information and will not be used in any manner related to determining eligibility for employment with the district. Full Name: Last first middle Social Security #: Date of Birth (mm/dd/yyyy : Sex: Male Female Ethnicity: Black White/Other Signature:

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