We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital or veteran status, the presence of a medical condition or handicap that is not job related, or any other legally protected status.

An Equal Opportunity Employer

PERSONAL DATA
* Required Fields

Date of application:
Attach Resume:	(optional)
Name (Last, First, Middle): *	,

Current Address: *
Current City, State, Zip: *	,

- Other address where you may be reached -
Other Address:
Other City, State, Zip:	,
Home Phone: *
Work Phone:
Cell Phone:
Email:
Social Security Number:
Name used on records if different from present name (for reference checks):

POSITION DATA

Position for which you are applying:

Date available: *	MM/DD/YYYY
Are you a former Henderson ISD employee? * YesNo
If yes, give dates of employment:


GENERAL INFORMATION Are you aware of any reasons you would not be able to perform the duties of the position for which you are applying? * YesNo
If yes, please explain:
Do you have a relative who is a member of the Henderson ISD Board of Education? * YesNo
If yes, please give the name of relative and relationship:
Have you been convicted of or pled guilty on no contest(no lo contendere) to a felony or an 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. Indicate whether the charges were dismissed as a condition of probation, suspension or deferred adjudication: Note: Conviction of a felony 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.

PROFESSIONAL DATA
Omit references to organizations that would reveal race, age, ethnic origin, or religous persusion.

Publications/Articles:
Seminars/Workshops conducted:
Other related professional activities:

CERTIFICATION STATUS

None

Valid Texas

Valid Other State

Passed the appropriate TExES exam(s) for certification

Currently Enrolled in Alternative Certification Program.

List Level and Areas of Certification.

EDUCATION/TRAINING
Schools Attended: List all applicable information.

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Certificate:
Year Graduated (College only):

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Certificate:
Year Graduated (College only):

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Certificate:
Year Graduated (College only):

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Certificate:
Year Graduated (College only):

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Certificate:
Year Graduated (College only):

Name of School and Location:
Course of Study- Major/Minor Fields:
Diploma/Degree:
Certificate:
Year Graduated (College only):

TEACHING EXPERIENCE
List teaching experience beginning with most recent years.

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

Total Creditable Years:

OTHER WORK EXPERIENCE
Please provide a complete listing of all other jobs or administrative positions you have held in the past 10 years.

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

Name of School and Location:
Type of Assignment:
Dates Taught:
Reason for Leaving:

REFERENCES
Please list below references who may be contacted regarding your work history. Please include all managers/supervisors at the last two employing organizations who evaluated or supervised your performance.

Full Name:
School District/Firm Name:
Mailing Address:
Phone:
Position/Title:

Full Name:
School District/Firm Name:
Mailing Address:
Phone:
Position/Title:

Full Name:
School District/Firm Name:
Mailing Address:
Phone:
Position/Title:

Full Name:
School District/Firm Name:
Mailing Address:
Phone:
Position/Title:

PERSONAL STATEMENT
Please make a statement concerning your reasons for desiring a position with the Henderson ISD.

Please review and check where indicated

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. My signature below authorizes the school district to conduct a background investigation and authorizes release of information in connection with my application for employment. The investigation will include a criminal history record check as required by Texas Educational Code §22.083. It may also include information from previous employers and educational institutions, personal references and other appropriate sources. I waive my right of access to any such information and without limitation hereby release the school district and the reference sources from any liability in connection with its release or use. 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 a period of one year. Any applicant wishing to be considered for employment beyond this time period may request by letter that the application be updated and maintained in the active file for another year.

I have read and understand these conditions of employment.