Employment Application for Teachers and Administrators

(any Region 2 District)

This application is not for employment at ESC-2.

Region 2 districts consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital status, veteran or military status, disability, or any other legally protected status.

Fill in all applicable information. All items with * must be completed.  Incomplete forms will not be posted.

All information is transmitted via a secure connection and will only be viewed by members of the Personnel Services Cooperative.

This information will not be given out to any other sources.

Personal Data  *Date application completed:      

 

*Current Name and Address:

 

 

 

 Last Name

  First Name

  Middle Initial

  

 

 

 

  
Street/Box  City State Zip

*Other Address where you may be reached:

*Work phone:     *Home phone      

Other name that may appear on records:

(Used for certification, reference, and criminal history record checks)
Position Data *List the position(s) you are applying for      

Do not send credentials (resume, certificates or licenses, transcripts).  These will be requested by interested districts.

*Date you can begin work:            

*Have you been employed by a Region 2 district in the past? Yes No 

If you answered *yes, which district(s)             (to select more than one, hold down the control key and click)

If yes, when?

Education/Training *

Name and location of

schools attended

 Course of study and major/minor

Diploma, degree, certificate,

or license held

Year graduated

(College only)
     
Certification

*Certificate or license currently held: (Select at least one.  Hold control key to select more than one)

 

Other state

 

*Level(s) of Certification:           

 

*Areas of Certification/Endorsements (as listed on certification): (to select more than one, hold down the control key and click)

              

Teaching Experience *List teaching experience beginning with most recent years.

Name and location

of school

Type of

assignment

Dates

taught

Reason for

leaving
Other Work Experience *Please provide a list of 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
Professional Data

*Please list relevant professional activities. Omit references to organizations that would reveal race, age, ethnic origin, or religion.

Papers/articles published:

Seminars/workshops conducted:

Other related professional activities:

 
General Information *Have you ever 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)? 

                         

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 places of employment.

Full name of

reference

School district/

firm name

Mailing

Address

Position/Title

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 I 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 previous page to give you any and all information concerning my 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.

to be signed and dated at the time of interview by district.

 

  

Signature

Date

This application becomes the property of the hiring district.  The hiring district reserves the right to accept or reject it.  This application shall be considered active for 12 months.  If you have not received a response during this time period, you may reapply or reactivate your application.

Please proofread your application before clicking the Submit button.

If/when you need to update or change information contained in this application after submitting, you must email Faye Stone.