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Your name
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Your email
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I. Personal Data:
 
Date of Application

Date Available

Social Security
       
Name:  

  Last First Middle
         
Address:
  Street/ Box City State Zip
       
Work Phone:

Home Phone:
   
Position of:

       
Starting Date:  

Year:

  

Credentials included with application:  
Resume
All Teaching & Professional certificates (front & back, if appropriate)
All Transcripts showing degrees
Not Applicable
 
Former School District Information:  
Former employee of:   ISD who resigned in
Not Applicable

II. Education
 *please note that you may type in more information than the field will hold. All your information will be sent in the email.
College/ University Location Dates Major Field of Study Minor Field of Study Type of Degree Year Earned
             
             
             

III. Certification

    A. Type of Certification held now:

    []    None                                                                                   
    []    Valid Texas
    []    Valid Other State * please indicate which state.                                                
    []    Emergency (Texas)
    []    Texas one-year certificate, which expires: * example: 05/2006  
    []    Texas temporary administrative, which expires: * example: 05/ 2006  

    B. Areas of Specialization

  []     Administrator []     Secondary (Junior and Senior High)
  []     Superintendent []     All Level Art
  []     Principal []     All Level Health and PE
  []     Mid-Management Administrator []     All Level Music
  []     Elementary []     Librarian
  []     Elementary and Kindergarten []     Counselor
     
  []     Special Education (specify)    
  []     Vocational (specify)    
  []     Nurse  
  []     Visiting Teacher  
  []     Supervisor  
  []     Others (specify)    
 

IV. Teaching Experience
 *please note that you may type in more information than the field will hold. All your information will be sent in the email.

School District, University
or Private School		 Location
City/ State		 Grades/ Subjects
Taught		 Dates Taught Reason for
Leaving

Total Creditable years: (This must be filled in. Only teaching full-time in college, public school,
or in an accredited private school is creditable.)

 V. Other Work Experience
 Please give a complete listing of all jobs or administrative positions you have held in the last ten years.
*please note that you may type in more information than the field will hold. All your information will be sent in the email.
School District/ Firm Name Position Dates Employed Reason for Leaving

VI. Professional Data

Publications/ Articles:

Professional organizations and offices:

Seminars/ workshops conducted:

Other related professional activities:

VII. General Information

Do you have any physical or health impairments that would limit your ability to perform the job(s) for which you are applying?

[] Yes        [] No
If yes, please explain:

How many days have you lost as a result of personal illness during the last three years?

Do you have a relative who is either a member of the Chilton ISD Board of Education or who is employed in any capacity in the Chilton ISD?

[] Yes        [] No
If yes, please give the following information:
Name of Relative Relationship Position Held

Have you ever been convicted of a felony? 

[] Yes        [] No
If yes, please explain:

Have you ever been asked to resign or been discharged through due process from any position, teaching, or otherwise?

[] Yes        [] No
If yes, please explain:

 VIII. Employment References:
Please list below references who may be contacted regarding your work history.
*please note that you may type in more information than the field will hold. All your information will be sent in the email.
School District/ Firm Name Mailing Address Area Code/ Phone Immediate Supervisor Dates Employed

IX. Personal Statement:
Please make a statement concerning your reasons for desiring a position with the Chilton School District.
 

X. Verification:

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge. I understand that, if employed, any falsified information may be considered sufficient cause for dismissal. You are authorized to make an investigation of my education and work history.

[] Agree        [] Disagree

 

Addendum to Application
The Chilton Independent School District is required by state law to obtain criminal history record information on all applicants for employment with the district (Texas Education Code Section § 21.917).

I understand the information set forth below will be used by the district solely for the purpose of obtaining criminal history record information and will not be used in any manner related to determining eligibility for employment with the district.

Full Name:
  Last, First Middle
Social Security No.
Date of Birth ex: 07-15-69
Driver License No.
Sex
Ethnicity

Cover Sheet
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Resume
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References
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* the above items are not required for your email to be sent, only send what you have.