Employment Application for Professional Personnel

PERSONAL DATA
 * Required Fields
The following documents may be attached below or e-mailed to nlee@jisd.org
Attach Transcript/Degree:  
Attach Resume:  (optional)
Eligibility Letter from Alternative Certification Program:  (Required if Applicable)
Name (Last, First, Middle): *  ,    
Current Address: *
Current City, State, Zip: *  ,    

- Other address where you may be reached -
Other Address:
Other City, State, Zip:  ,    
Home Phone: *
Work Phone:
Cell Phone:
Email:
Name used on records if different from present name:
Name (Last, First, Middle):  ,    

If hired, can you show verification of your legal right to work in the United States of America?  *

Will you require sponsorship to work in the United States? *
POSITION DATA
Date available: *   MM/DD/YYYY
Please select the specific position for which you are applying (one per application) *
Category Position
Elementary
4-8
Secondary (7-12)
Special Education
Other:
Administrator:

Additional: (you may add any of the following)
Additional information for a specific position, list here: 
CERTIFICATION DATA
Types of Certificate:
Valid Texas Certificate
Valid Texas Probationary Certificate
     Expiration Date:  MM/DD/YYYY
Eligible for Probationary Certificate
     Name/phone number for Alternative program:
Valid Other State Certificate
     List:
Texas One-Year Certificate (for out of state, not for alternative certification)
     List:
*CERTIFICATIONS(Check ALL valid TEXAS Certifications):

Early Childhood(PK/K)

EC-4
     Generalist
     Bilingual Generalist
     Core Subjects

Elementary
     EC-6
     Elementary 1-8
     EC-4
     EC-4 Bilingual

4-8
     Generalist
     Core Subjects
     Bilingual Generalist
     Language Arts/Reading
     Language Arts/Reading/Social Studies
     Math
     Math/Science
     Science
     Social Studies

Secondary or 8-12
     English Language Arts
     Math
     Social Studies - History
     Social Studies - Government
     Journalism
     Technology
     Health Science Technology Education
     Business Administration
     Business
     Social Studies - Composite
     Science - Physical Science
     Science - Chemistry
     Science - Composite
     Science - Biology/Life Science
     Health
     French
     Spanish
     Dance
     Theatre Arts
     Speech
     Health
     PE

All-Level
     Art
     Music
     PE
     Special Education
     Bilingual Supplemental
     ESL
     Counselor
     Diagnostician
     Librarian/Learning Resource Specialist
     Nurse
     LSSP
     Master Reading Teacher
     Teacher of Students with Visual Impairments

Administrator
     Principal
     Mid-Management
     Superintendent
     Supervisor

NONE

Applied but not yet received

Licenses
     Occupational Therapist
     RN
     LVN
     Physical Therapist
     LSSP
     Speech Therapy Pathologist Asst.
     Speech Therapist/Pathologist
     Athletic Trainer
GENERAL INFORMATION
Are you a former Jacksonville ISD employee? *
If yes, give dates of employment:

Do you have a relative who serves on the Board of Education or is an employee of Jacksonville ISD? *
If yes, please give the name of relative and relationship:

Have you been convicted of, pled guilty or no contest(nolo contendere) 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)? *
If yes, please state where, when and the nature of the offense: indicate the outcome of proceedings:

(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.)
EDUCATION/TRAINING
Schools Attended: List all applicable information.
Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Month and Year Graduated (College only):  MM/YY
Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Month and Year Graduated (College only):  MM/YY
Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Month and Year Graduated (College only):  MM/YY
Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Month and Year Graduated (College only):  MM/YY
TEACHING EXPERIENCE
List teaching experience beginning with most recent years.
Name of School and Location:
Specific Assignment:
Dates Taught (MM/YY)
  From:   To:
Reason for Leaving:
Name of School and Location:
Specific Assignment:
Dates Taught (MM/YY)
  From:   To:
Reason for Leaving:
Name of School and Location:
Specific Assignment:
Dates Taught (MM/YY)
  From:   To:
Reason for Leaving:
Name of School and Location:
Specific Assignment:
Dates Taught (MM/YY)
  From:   To:
Reason for Leaving:
Total Creditable Years of Experience: *
OTHER WORK EXPERIENCE
Please list all other jobs or administrative positions you have held in the past 10 years.
School District/Firm Name:
Position/Title:
Dates Employed:
Reason for Leaving:
School District/Firm Name:
Position/Title:
Dates Employed:
Reason for Leaving:
School District/Firm Name:
Position/Title:
Dates Employed:
Reason for Leaving:
School District/Firm Name:
Position/Title:
Dates Employed:
Reason for Leaving:
REFERENCES
Please list references the district can contact regarding your work history. Include all managers and supervisors who evaluated or supervised your performance at your last two employers.
Full Name:
School District/Firm Name:
Position/Title:
Mailing Address:
Phone:
Full Name:
School District/Firm Name:
Position/Title:
Mailing Address:
Phone:
Full Name:
School District/Firm Name:
Position/Title:
Mailing Address:
Phone:
Full Name:
School District/Firm Name:
Position/Title:
Mailing Address:
Phone:
PERSONAL STATEMENT
In this space, please share your reasons for desiring a position with Jacksonville ISD:
Please review and check where indicated

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 on the application to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise. I waive my right of access to any such information and, without limitation, I hereby release the Jacksonville Independent School District and references from liability for any damage that may result from their furnishing the information to you. This application becomes the property of the school district. The district reserves the right to accept or reject it. This application shall be considered active for a period of one year. Any applicant who wishes to be considered for employment beyond this time period must submit a new application. I understand that the district is authorized by Texas Education Code 22.083 to obtain criminal history on the applicants the district intends to employ.


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