Needville Independent School District
Needville Independent School District P. O. Box 412 Needville, Texas 77461 Phone (979) 793-4308 Fax (979) 793-3823 Application for Employment of Service/Support Personnel & Substitute Teacher Date of application ________________________________ Name ___________________________________________________________________________ Last
First
Middle Initial
Current Address _________________________________________________________________ Street/Box
City
State
Zip Code
Other Name that may appear on records _____________________________________________ (used for certification, reference, & criminal history records checks)
Other address where you may be reached _____________________________________________ Work phone ____________________________ Home phone _____________________________ Email _______________________________________________ ********************************************************************************* Position(s) for which you are applying. Please check all applicable positions. Type of employment:
______Full-time ______Part-time ______Summer Only
______Bus Driver (Do you have a CDL? _______ Are you willing to get one? ________ ) ______ Secretary/Office Clerk ______ Teacher Aide ______Maintenance (Check appropriate skills) ______Welder ______Carpenter ______Electrician
______General
______Plumber
______ Cook Will you substitute? ( Yes / No ) ______ Substitute Teacher ** Do you use a computer in your present position? ( Yes / No ) Please describe your computer skills/experience. _______________________________________ ________________________________________________________________________________ **Please contact the administrator of each campus for which you are applying to substitute teach. The campus administrator will need to sign below. Needville Elementary ____________________________ Needville Jr. High __________________________ Needville Middle _____________________________ Needville High School _____________________
Have you ever been employed by Needville I.S.D. in the past? ______ Yes _____ No If you answered yes, provide dates of employment __________________________________________ Date you can begin work __________________________________ Check the highest level of education attained: _____ Not a high school graduate (circle last grade completed) 1 2 3 4 5 6 7 8 9 10 11 12 _____ High School graduate
_____ GED
_____ Two or more years of college
_____ Bachelor’s degree
_____ Master’s degree
_____ Other training or education
Licenses and certificates held ___________________________________________________________
Education/Training Name & Location of schools attended
Course of Study and Major/Minor
Diploma, degree, certificate or license held
Year graduated (College Only)
Position /Title
Dates Employed
Reason for Leaving
Work Experience Employer and Location
Special Skills List specific skills, software proficiency and any machines or equipment you can operate. Include typing speed and number of years of experience. 1. __________________________________________ 2. _____________________________________ 3. __________________________________________ 4. _____________________________________ 5. __________________________________________ 6. _____________________________________
General Information Do you have a relative who serves on the Needville ISD Board of Education? _____ Yes _____ No If yes, please provide the relative’s name and relationship: ________ _____________________________________________________________________________________ Have you ever been convicted of, plead guilty or no contest (nolo contender) to, or received probation, suspension, or deferred adjudication for a felony or 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.) Are you a retired member of TRS? ________Yes ________ No If so, date of retirement. _________________________
References Please list references the district can contact regarding your work history. Please include all managers and supervisors who evaluated or supervised your performance at your last two employers. Full name of reference and position/title
School district/ business name
Mailing address
Area code/ Phone number
Verification 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 to give you any and all information concerning any 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.
_________________________________
_____________
Signature
Date
This application becomes the property of the district. The district reserves the right to accept or reject it. This application shall be considered active for 2 years. If you have not received a response during this time period, you may reapply or reactivate your application.
We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital status, veteran or military status, the presence of a medical condition, disability, or any other legally protected status.
The district Title IX Coordinator is Beth Briscoe, Assistant Superintendent, NISD, P. O. Box 412, Needville, Texas 77461, phone # 979-793-4308.
CONFIDENTIAL*
The Needville Independent School District is authorized by state law to obtain criminal history record information on applicants the district intends to employ (Texas Education Code 22.083). The information requested below is necessary to obtain criminal history record information. Please print. Name ________________________________________________________________________ Last First Middle Date of Birth ____________________
Social Security Number __________________
Sex: _____ Male _____ Female
Ethnicity: _____ Black _____ White/Other
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 personnel office.
DPS Computerized Criminal History (CCH) Verification (AGENCY COPY) I,
, have been notified that a Computerized Criminal APPLICANT or EMPLOYEE NAME (Please print)
History (CCH) verification check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB identifiers I supply. Because the name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history, the organization conducting the criminal history check for background screening is not allowed to discuss any criminal history record information obtained using the name and DOB method. Therefore, the agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search. For the fingerprinting process I will be required to submit a full and complete set of my fingerprints for analysis through the Texas Department of Public Safety AFIS (Automated Fingerprint Identification System). I have been made aware that in order to complete this process I must make an appointment with L1 Enrollment Services, submit a full and complete set of my fingerprints, request a copy be sent to the agency listed below, and pay a fee of $24.95 to the fingerprinting services company, L1 Enrollment Services. Once this process is completed and the agency receives the data from DPS, the information on my fingerprint criminal history record may be discussed with me.
(This copy must remain on file by your agency. Required for future DPS Audits) ___________________________________ Signature of Applicant or Employee
Date
Agency Name (Please print)
Please: Check and Initial each Applicable Space CCH Report Printed: YES
NO
initial
Purpose of CCH: Agency Representative Name (Please print)
___________________________________ Signature of Agency Representative
Hire
Not Hired
initial
d Date Printed:
initial
/ Destroyed Date:
initial
Retain in your files Date Rev. 02/2011
You can save your completed application, email it to Charles Roehling at [email protected] or print it out and mail it to Charles Roehling at P.O. Box 412, Needville Tx. 77461.
First
Middle Initial
Current Address _________________________________________________________________ Street/Box
City
State
Zip Code
Other Name that may appear on records _____________________________________________ (used for certification, reference, & criminal history records checks)
Other address where you may be reached _____________________________________________ Work phone ____________________________ Home phone _____________________________ Email _______________________________________________ ********************************************************************************* Position(s) for which you are applying. Please check all applicable positions. Type of employment:
______Full-time ______Part-time ______Summer Only
______Bus Driver (Do you have a CDL? _______ Are you willing to get one? ________ ) ______ Secretary/Office Clerk ______ Teacher Aide ______Maintenance (Check appropriate skills) ______Welder ______Carpenter ______Electrician
______General
______Plumber
______ Cook Will you substitute? ( Yes / No ) ______ Substitute Teacher ** Do you use a computer in your present position? ( Yes / No ) Please describe your computer skills/experience. _______________________________________ ________________________________________________________________________________ **Please contact the administrator of each campus for which you are applying to substitute teach. The campus administrator will need to sign below. Needville Elementary ____________________________ Needville Jr. High __________________________ Needville Middle _____________________________ Needville High School _____________________
Have you ever been employed by Needville I.S.D. in the past? ______ Yes _____ No If you answered yes, provide dates of employment __________________________________________ Date you can begin work __________________________________ Check the highest level of education attained: _____ Not a high school graduate (circle last grade completed) 1 2 3 4 5 6 7 8 9 10 11 12 _____ High School graduate
_____ GED
_____ Two or more years of college
_____ Bachelor’s degree
_____ Master’s degree
_____ Other training or education
Licenses and certificates held ___________________________________________________________
Education/Training Name & Location of schools attended
Course of Study and Major/Minor
Diploma, degree, certificate or license held
Year graduated (College Only)
Position /Title
Dates Employed
Reason for Leaving
Work Experience Employer and Location
Special Skills List specific skills, software proficiency and any machines or equipment you can operate. Include typing speed and number of years of experience. 1. __________________________________________ 2. _____________________________________ 3. __________________________________________ 4. _____________________________________ 5. __________________________________________ 6. _____________________________________
General Information Do you have a relative who serves on the Needville ISD Board of Education? _____ Yes _____ No If yes, please provide the relative’s name and relationship: ________ _____________________________________________________________________________________ Have you ever been convicted of, plead guilty or no contest (nolo contender) to, or received probation, suspension, or deferred adjudication for a felony or 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.) Are you a retired member of TRS? ________Yes ________ No If so, date of retirement. _________________________
References Please list references the district can contact regarding your work history. Please include all managers and supervisors who evaluated or supervised your performance at your last two employers. Full name of reference and position/title
School district/ business name
Mailing address
Area code/ Phone number
Verification 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 to give you any and all information concerning any 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.
_________________________________
_____________
Signature
Date
This application becomes the property of the district. The district reserves the right to accept or reject it. This application shall be considered active for 2 years. If you have not received a response during this time period, you may reapply or reactivate your application.
We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital status, veteran or military status, the presence of a medical condition, disability, or any other legally protected status.
The district Title IX Coordinator is Beth Briscoe, Assistant Superintendent, NISD, P. O. Box 412, Needville, Texas 77461, phone # 979-793-4308.
CONFIDENTIAL*
The Needville Independent School District is authorized by state law to obtain criminal history record information on applicants the district intends to employ (Texas Education Code 22.083). The information requested below is necessary to obtain criminal history record information. Please print. Name ________________________________________________________________________ Last First Middle Date of Birth ____________________
Social Security Number __________________
Sex: _____ Male _____ Female
Ethnicity: _____ Black _____ White/Other
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 personnel office.
DPS Computerized Criminal History (CCH) Verification (AGENCY COPY) I,
, have been notified that a Computerized Criminal APPLICANT or EMPLOYEE NAME (Please print)
History (CCH) verification check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB identifiers I supply. Because the name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history, the organization conducting the criminal history check for background screening is not allowed to discuss any criminal history record information obtained using the name and DOB method. Therefore, the agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search. For the fingerprinting process I will be required to submit a full and complete set of my fingerprints for analysis through the Texas Department of Public Safety AFIS (Automated Fingerprint Identification System). I have been made aware that in order to complete this process I must make an appointment with L1 Enrollment Services, submit a full and complete set of my fingerprints, request a copy be sent to the agency listed below, and pay a fee of $24.95 to the fingerprinting services company, L1 Enrollment Services. Once this process is completed and the agency receives the data from DPS, the information on my fingerprint criminal history record may be discussed with me.
(This copy must remain on file by your agency. Required for future DPS Audits) ___________________________________ Signature of Applicant or Employee
Date
Agency Name (Please print)
Please: Check and Initial each Applicable Space CCH Report Printed: YES
NO
initial
Purpose of CCH: Agency Representative Name (Please print)
___________________________________ Signature of Agency Representative
Hire
Not Hired
initial
d Date Printed:
initial
/ Destroyed Date:
initial
Retain in your files Date Rev. 02/2011
You can save your completed application, email it to Charles Roehling at [email protected] or print it out and mail it to Charles Roehling at P.O. Box 412, Needville Tx. 77461.
