Dawson Independent School District
Dawson Independent School District Application for Employment “An Equal Opportunity Employer”
P.O. Box 180 Welch, Texas 79377 Phone: 806.489.7461 Fax: 806.489.7463 We consider applications 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. FOR SCHOOL USE ONLY Date Received
Date Reviewed
Actual Interview Date(s)
rPERSONAL DATA Full Name:____________________________________________________________________ Last
First
M.I.
Social Security Number
Present Address: _____________________________________________________________ Street Address Apartment/Unit # _________________________________________ City State ZIP Code Home Work E-Mail Phone: ( ) Phone: ( ) Address:___________________________________ Permanent address: ________________________________________________________________________ Street Address Apartment/Unit # _____________________________________________________________________________________ City State Zip Code
Yes
No
Have you been rehired to your present Position? If “No”, explain: __________________________________________________________________________________________ Yes No Have you been discharged from or not rehired in a teaching position during the past 6 years? If so, Where? When? Why? __________________________________________________________________________________________ YES No Have you previously applied with Dawson I.S.D.? Years _____ Are you a retiree of TRS? Yes No Years _____ Yes No Have you ever been employed by Dawson I.S.D.?
Position Data Position Applied for: First Choice Credentials included with application:
Second Choice Third Choice Resume All transcripts showing degrees All teaching and professional certificates (front and back, if appropriate)
Date Available for employment:________________________________
EDUCATIONAL AND PROFESSIONAL PREPARATION College/University
Location
Dates Attended From To
Date of Graduation
Degree or diploma
Subject Major Sem. Hrs.
Subject Minor Sem. Hrs.
What grade point average do you have in your teaching major?_______
Over-all grade point average?________
Grade point scale:________ Highest Degree received: Major:
Minor:
You must send copies of college/university transcripts including grades and confirmation of degree(s) to the attention of the Personnel Director.
MISCELLANEOUS DATA Why do you wish to leave your present position or location?
Why do you want to be employed by the Dawson ISD?
What have you done recently to improve yourself professionally?
To what professional or honorary organizations do you belong?
What high school and college distinctions have been awarded to you?
Are you proficient in any languages other than English? If so, please list:
CERTIFICATION Name of Professional Certificates you hold
State
Date of Expiration
Subjects and/or grades covered by certification
RECORD OF PROFESSIONAL EXPERIENCE Name of Employer (Most recent experience first)
Dates attended From
To
Subjects and / or Grades Taught
Number of Years
Immediate Supervisor Name Telephone
Total Years professional experience: _______ May we contact your current employer?
YES
NO
REFERENCES Full Name of References
Position
School Address Street, City, and State
Telephone
Have you established a placement file? Yes
Where:
No
Please list an alternative contact if we are unable to reach you. Name:
Address:
Telephone:
OTHER INFORMATION YES NO Have you ever been convicted of a felony or 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:____________
YES
Have you ever used or possessed illegal drugs?
NO
If yes, please explain:__________
YES NO
Have you ever had a license suspended, revoked, or canceled? If yes, explain:________
YES NO
Are any criminal charges or proceedings pending against you? If yes, explain:___________ Do you have a relative who is a member of the Dawson ISD Board of Education?
YES
NO
If yes, please give the name of relative and relationship:_________________________________________
This application will remain on file for two years only; it must be renewed if further consideration is desired. You will receive no further reply unless favorable consideration is given your application. I hereby certify that the information presented in this application to the best of my knowledge is true, accurate, and complete. Any falsification of this record will be sufficient cause for disqualification. Furthermore, it is understood that this application becomes the property of the Dawson Independent School District which reserves the right to accept or reject it. I hereby authorize Dawson Independent School District to contact any and all references regarding previous employment and to obtain any criminal history record information relevant to this application for employment from any pertinent source in accordance with the Texas Education Code Section 22.083. I further authorize any law enforcement agency, including, but not limited to, any department or the Department of Public Safety as well as the Texas Department of Corrections to furnish the Dawson Independent School District any such record. References, placement folder information, and information which become a part of this record may be revealed to all persons who participate in the selection of employees.
______________________________________________________ Signature of Applicant Driver’s License Number____________________________
______________________________ Date State__________________________
Return to:
Personnel/Administration Dawson I.S.D. P.O. Box 180 Welch, Texas 79377
Phone:
(806) 489-7568
Fax: (806) 489-7463
We consider applications 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.
P.O. Box 180 Welch, Texas 79377 Phone: 806.489.7461 Fax: 806.489.7463 We consider applications 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. FOR SCHOOL USE ONLY Date Received
Date Reviewed
Actual Interview Date(s)
rPERSONAL DATA Full Name:____________________________________________________________________ Last
First
M.I.
Social Security Number
Present Address: _____________________________________________________________ Street Address Apartment/Unit # _________________________________________ City State ZIP Code Home Work E-Mail Phone: ( ) Phone: ( ) Address:___________________________________ Permanent address: ________________________________________________________________________ Street Address Apartment/Unit # _____________________________________________________________________________________ City State Zip Code
Yes
No
Have you been rehired to your present Position? If “No”, explain: __________________________________________________________________________________________ Yes No Have you been discharged from or not rehired in a teaching position during the past 6 years? If so, Where? When? Why? __________________________________________________________________________________________ YES No Have you previously applied with Dawson I.S.D.? Years _____ Are you a retiree of TRS? Yes No Years _____ Yes No Have you ever been employed by Dawson I.S.D.?
Position Data Position Applied for: First Choice Credentials included with application:
Second Choice Third Choice Resume All transcripts showing degrees All teaching and professional certificates (front and back, if appropriate)
Date Available for employment:________________________________
EDUCATIONAL AND PROFESSIONAL PREPARATION College/University
Location
Dates Attended From To
Date of Graduation
Degree or diploma
Subject Major Sem. Hrs.
Subject Minor Sem. Hrs.
What grade point average do you have in your teaching major?_______
Over-all grade point average?________
Grade point scale:________ Highest Degree received: Major:
Minor:
You must send copies of college/university transcripts including grades and confirmation of degree(s) to the attention of the Personnel Director.
MISCELLANEOUS DATA Why do you wish to leave your present position or location?
Why do you want to be employed by the Dawson ISD?
What have you done recently to improve yourself professionally?
To what professional or honorary organizations do you belong?
What high school and college distinctions have been awarded to you?
Are you proficient in any languages other than English? If so, please list:
CERTIFICATION Name of Professional Certificates you hold
State
Date of Expiration
Subjects and/or grades covered by certification
RECORD OF PROFESSIONAL EXPERIENCE Name of Employer (Most recent experience first)
Dates attended From
To
Subjects and / or Grades Taught
Number of Years
Immediate Supervisor Name Telephone
Total Years professional experience: _______ May we contact your current employer?
YES
NO
REFERENCES Full Name of References
Position
School Address Street, City, and State
Telephone
Have you established a placement file? Yes
Where:
No
Please list an alternative contact if we are unable to reach you. Name:
Address:
Telephone:
OTHER INFORMATION YES NO Have you ever been convicted of a felony or 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:____________
YES
Have you ever used or possessed illegal drugs?
NO
If yes, please explain:__________
YES NO
Have you ever had a license suspended, revoked, or canceled? If yes, explain:________
YES NO
Are any criminal charges or proceedings pending against you? If yes, explain:___________ Do you have a relative who is a member of the Dawson ISD Board of Education?
YES
NO
If yes, please give the name of relative and relationship:_________________________________________
This application will remain on file for two years only; it must be renewed if further consideration is desired. You will receive no further reply unless favorable consideration is given your application. I hereby certify that the information presented in this application to the best of my knowledge is true, accurate, and complete. Any falsification of this record will be sufficient cause for disqualification. Furthermore, it is understood that this application becomes the property of the Dawson Independent School District which reserves the right to accept or reject it. I hereby authorize Dawson Independent School District to contact any and all references regarding previous employment and to obtain any criminal history record information relevant to this application for employment from any pertinent source in accordance with the Texas Education Code Section 22.083. I further authorize any law enforcement agency, including, but not limited to, any department or the Department of Public Safety as well as the Texas Department of Corrections to furnish the Dawson Independent School District any such record. References, placement folder information, and information which become a part of this record may be revealed to all persons who participate in the selection of employees.
______________________________________________________ Signature of Applicant Driver’s License Number____________________________
______________________________ Date State__________________________
Return to:
Personnel/Administration Dawson I.S.D. P.O. Box 180 Welch, Texas 79377
Phone:
(806) 489-7568
Fax: (806) 489-7463
We consider applications 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.
