Employment Application for Service and Support Personnel

PERSONAL DATA
* Required Fields

Attach Resume:	(optional)
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? * YesNo
Will you require sponsorship to work in the United States? * YesNo

POSITION DATA

Please select all for which you wish to apply: *
Instructional Aide Secretary/Clerical Nurse Aide Food Service Custodial Maintenance Technology Bus Driver Bus Monitor Security Guard Special Needs Health Aide (Part time) Warehouse Employee PEIMS Assistant--Technology Dept. PE Aide Computer Technician Head Start Instructional Aide Instructional Aide (Bilingual) LVN (Licensed Vocational Nurse) Purchasing Clerk Speech Therapy Aide (Bilingual) Computer/Media Technician Band Tutor Tutor Accompanist Bilingual Central Office Receptionist Substitute Police officer Administrative Assistant to Superintendent Central Office Data Entry Clerk / Receptionist Secretary to Bilingual Director Part Time Food Service Repair Technician Daycare Teacher Daycare Teacher/Caregiver in Charge Designee Mechanic Assistant Chief of Police Accounts Payable Clerk Campus Monitor
Type of Employment: *
Full-Time Part-Time Summer Only
Date you can begin work: *	MM/DD/YYYY
Have you ever been employed by this school district? * YesNo
If yes, give dates of employment:

EDUCATION/TRAINING

Check highest educational level attained: *

Not high school graduate (select last grade completed) 123456789101112

N/A
High School Graduate
GED
Less than two years of college
Two or more years of college
Bachelors degree
Masters degree

Other training or education

Licenses/certificates held

Schools Attended: List all applicable information:

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Year Graduated (College only):	MM/YY

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Year Graduated (College only):	MM/YY

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Year Graduated (College only):	MM/YY

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Year Graduated (College only):	MM/YY

WORK EXPERIENCE
Please provide a complete listing of all jobs or positions you have held in the past 10 years. List most recent first.

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:

List specific skills and any machines or equipment you can operate. Including typing speed and number of years of experience.

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

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.

I have read and understand these conditions of employment.

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