APPLICATION FOR PROFESSIONAL PERSONNEL

7950 John T. White Road Fort Worth, Texas 76120 817.446.3738
APPLICATION FOR PROFESSIONAL PERSONNEL
An Equal Opportunity Employer
Date of application

MonthDayYear
Date
Personal Data
Name: (Last, First, Middle Initial)
Mailing address (Street, City , State and zip)
E-mail address
example@example.com
Home phone
Format: (000) 000-0000.
Cell phone
Format: (000) 000-0000.
Other phone
Format: (000) 000-0000.
Other name that may appear on records
(Used for certification,reference, and criminal history record checks)
Position Data
List the position(s) for which you are applying
RésumeAll teaching and professional certificates or licensesAll transcripts showing degrees
Upload resume, teaching and professional certificates, licenses or transcripts

Cancelof
Date you can begin work

MonthDayYear
Date
If you answered yes, provide dates of employment

MonthDayYear
Date
YesNo
MonthDayYear
Date
Education/Training

Education/Training 1:
Name and Location of School Attended
Course of Study and Major/Minor
Diploma, degree, certificate, or license granted
Year Graduated (College only)
Education/Training 2:
Name and Location of School Attended
Course of Study and Major/Minor
Diploma, degree, certificate, or license granted
Year Graduated (College only)
Education/Training 3:
Name and Location of School Attended
Course of Study and Major/Minor
Diploma, degree, certificate, or license granted
Year Graduated (College only)
Education/Training 4:
Name and Location of School Attended
Course of Study and Major/Minor
Diploma, degree, certificate, or license granted
Year Graduated (College only)
Certification/Licensure
NoneValid TexasValid Other StateTexas One-Year (out-of-state/country)Other
If License Valid from Other State, list state:
If Texas One-Year License checked, list expiration date:
Category/Level(s) of Certification
Areas of specialization/supplemental Certificates/Endorsements (as listed on certification):
1.
2.
3.
4.
5.
6.
Teaching Experience

List teaching experience beginning with most recent years.
School 1:
Name and location of school
Type of assignment
Dates taught
Principal's name and phone number
Reason for leaving
School 2:
Name and location of school
Type of assignment
Dates taught
Principal's name and phone number
Reason for leaving
School 3:
Name and location of school
Type of assignment
Dates taught
Principal's name and phone number
Reason for Leaving
School 4:
Name and location of school
Type of assignment
Dates taught
Principal's name and phone number
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. Attach résumé if available.
Employer 1:
Employer name and location
Position/title held
Dates employed:
Supervisor's name and phone
Reason for leaving
Employer 2:
Employer name and location
Position/title held
Dates employed
Supervisor's name and phone
Reason for leaving
Employer 3:
Employer name and location
Position/title held
Dates employed
Supervisor's name and phone
Reason for leaving
Employer 4:
Employer name and location
Position/title held
Dates employed
Supervisor's name and phone
Reason for leaving
Please list references the school can contact regarding your work history.

Reference 1:
Full name of reference
School district/firm name
Mailing address
Position/title
Area code/phone number
Reference 2:
Full name of reference
School district/firm name
Mailing address
Position/title
Area code/phone number
Reference 3:
Full name of reference
School district/firm name
Mailing address
Position/title
Area code/phone number
Reference 4:
Full name of reference
School district/firm name
Mailing address
Position/title
Area code/phone number
General Information
YesNo
If yes, please provide the relative’s name and relationship
YesNo
If yes, please state where, when, and the nature of the offense
(A felony conviction is not an automatic bar to employment. The school 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 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.
Verification
Signature

Clear
Date

MonthDayYear
Date
This application becomes the property of the school. The school reserves the right to accept or reject it.

*Applicants for all positions are considered without regard to race, color, sex (including pregnancy), national origin, religion, age, disability, genetic information, veteran or military status, or any other legally protected status. Additionally, the school 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.
CRIMINAL HISTORY INFORMATION REQUEST
Confidential
The Key School is required to review the criminal history of applicants. The information requested below is necessary to obtain criminal history record information.
Last Name
First Name
Middle Name
Social Security Number
Date of birth

MonthDayYear
Date
Driver’s License (State and Number)
Address

Mailing Address

Street Address Line 2

CityState

Zip
MaleFemale
BlackWhite/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

Clear
Date

MonthDayYear
Date
This form will be removed from the application and filed separately in the HR office.
DPS Computerized Criminal History (CCH) Verification
I,
APPLICANT or EMPLOYEE NAME (Please print)
, acknowledge that a Computerized Criminal

History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure Website and may be based on name and Date of Birth (DOB) identifiers. (This is not a consent form, but serves as information for the applicant criminal history data may be found in Texas Government Code 411; Subchapter F. Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history record information (CHRI), therefore the organization conducting the criminal history check is not allowed to discuss with me any CHRI obtained using the name and DOB method.

Authority for this agency to access an individual’s

The agency may request that I also have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search as a condition of continued employment. Once this process is completed, the information on my fingerprint criminal history record may be discussed with me.

(This copy must remain on file by this agency. Required for future DPS Audits)

This form will be removed from the application and filed separately in the HR office.
Should be Empty:

APPLICATION FOR PROFESSIONAL PERSONNEL

An Equal Opportunity Employer

Personal Data

Position Data

Education/Training

Certification/Licensure

Teaching Experience

Other Work Experience

Please list references the school can contact regarding your work history.

General Information

Verification

CRIMINAL HISTORY INFORMATION REQUEST

Confidential

DPS Computerized Criminal History (CCH) Verification