LaPoynor ISD Professional Personnel Application

Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Other name that may appear on records:*

List the position(s) for which you are applying:*

Credentials included with application:*

ResumeAll teaching and professional certificates or licensesAll transcripts showing degrees

Date you can begin work*

Have you been employed by LaPoynor ISD in the past?*

YesNo

If you answered yes, provide dates of employment:

List all education and training:*

	Name and location of schools attended	Course of study and major/minor	Diploma, degree, certificate, or license	Year Graduated
Education/Training
Education/Training
Education/Training
Education/Training

Certificates or Licenses Currently Held:*

Areas of Specialization/Supplemental Certificates/Endorsements (as listed on certification):

List teaching experience beginning with most recent years.*

	Name and location of school	Type of assignment	Dates taught	Principal's name and phone	Reason for leaving
Teaching Experience
Teaching Experience
Teaching Experience
Teaching Experience

Please provide a list of all other jobs or administrative positions you have held in the past 10 years. Attach additional sheets if necessary. Attach resume if available.*

	Employer name and location	Position/Title Held	Dates Employed	Supervisor's Name and Phone	Reason for leaving
Other Work Experience
Other Work Experience
Other Work Experience
Other Work Experience

Please list references the district can contact regarding your work history.*

	Full name of reference	School District/Firm Name	Mailing address	Position/Title	Area Code/Phone Number
References
References
References
References

Do you have a relative who serves on the Board of Education or is an employee of LaPoynor ISD?*

YesNo

If yes, please list relatives name and relationship.

Have you ever been convicted of, pled guilty or no contest 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?

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).

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 sub sequent 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 required by Texas Education Code to review criminal history of applicants.*

*Applicants for all positions are considered without regard to race, color, sex (including pregnancy, , sexual orientation or gender identity), national origin, religion, age, disability, genetic information, veteran or military status, or any other legally protected status. Additionally, the district does not discriminate against an applicant who acts to oppose such discrimination or participates in the investigation of a complaint related to a discriminating employment practice.

This application becomes the property of the district. The district reserves the right to accept or reject it.

In accordance with Title IX, the district does not discriminate on the basis of sex and is required not to discriminate on the basis of sex in its educational programs or activities. The requirement not to discriminate extends to employment. Inquiries about the application of Title IX may be referred to the district’s Title IX coordinator, to the Assistant Secretary for Civil Rights of the Department of Education, or both.
Inquiries about the application of Title IX to employment should be referred to Title IX Coordinator, Marsha Mills, Superintendent, (903) 876-4057.

Attached Resume, Transcripts and any other necessary documentation

LaPoynor ISD

Criminal History Report