Galena Park Independent School District
Human Resource Services
14705 Woodforest Blvd
Houston, Texas 77015
(832) 386-1000
  
APPLICATION FOR AUXILIARY, PARAPROFESSIONAL, OR SUBSTITUTE EMPLOYMENT
I. PERSONAL INFORMATION
Required fields are denoted with a star (*)
Name *:
Last First Middle Social Security No. *
(Required for US Residents)
Address *:
Street or P.O. Box City State or Country * Zip Code *
(required for US Residents)
Home Phone *:
Secondary Phone #:
Secondary phone is:
Email Address :

(please verify - we may be contacting you at this address):		 Work phone
Pager
Mobile phone
Relative's phone
Other
CITIZENSHIP OR IMMIGRATION AND NATURALIZATION AND SERVICE DOCUMENTS *
     
United States Citizen
Alien Registration Card
Card Number:
Expiration Date:
Employment Authorization Card
Card Number:
Expiration Date:
Temporary Residence Card
Card Number:
Expiration Date:
II. POSITION INFORMATION
Check category and state specific position applying and qualified for *:
Clerk/Clerical Computer Technician HVAC Chiller Plant Operator
Secretary Bus Aide HVAC Low Temperature
Teacher Aide Bus Driver Locksmith
Teacher Aide-Bilingual Sub-Teacher (minimum 48 college hours) Painter
HomeGrown Sub-Secretary Vehicle Mechanic
General Laborer Sub-Teacher Aide Warehouse
Custodian Sub-Teacher Aide Bilingual Carpenter
Crossing Guard Sub-Custodial Electrician
Dispatcher Sub-Food Services Information Technology
Food Services Sub-Transportation Other
 
III. EDUCATIONAL BACKGROUND

Name of Institution
Location
Dates Attended
From/To
Date of Graduation
Level of Degrees/Diploma
# of College Hours
Major
Minor

IV. CERTIFICATE AND LICENSE INFORMATION
Type of Certificate/License
Date Issued
MM/DD/YYYY
Date Expired
MM/DD/YYYY
State

Have you ever worked for Galena Park I.S.D.? * Yes No If yes, when?


           
Have you ever been terminated for cause, been asked to resign, had a contract non-renewed, or left employment involuntarily? * Yes No


Are you related to any employee or board member? * Yes No If yes, name:
Position: Relationship:

V. WORK EXPERIENCE (full time)
List in order all work. Account for every year from high school to the present. Use additional page if necessary.
FROM
MM/YYYY
TO
MM/YYYY
Name and Address of Employer
Supervisor
Supervisor's Phone No.
Kind of Work

VI. WORK REFERENCES
Name
Position
Address
Telephone Number


Government agencies are required to make periodic reports on the status of applicants for reasons of affirmative action. Further, the Texas Education Code authorizes school districts to obtain information related to criminal history records. As a governmental agency, we comply with affirmative action requirements and Texas law regulations.

I do hereby agree, consent and direct any person or entity maintaining in any form my criminal history to release all such information upon the request of the Galena Park Independent School District.

I do further agree and permit the Galena Park Independent School District to obtain from any law enforcement source or entity information relating to my personal background, my moral character and my fitness to instruct students or work in an environment with students of the Galena Park Independent School District, and do hereby expressly direct that any such person or entity release such information upon the request of the Galena Park Independent School District.

I hereby release, discharge and exonerate the Galena Park Independent School District, its agents or representatives, and any person or entity so furnishing from any and all liability of every kind arising therefrom. Information will be kept in a separate file. The foregoing consent and release is valid and binding so long as I hold or apply for employment with the Galena Park Independent School District.

  
         
Have you ever been convicted of a felony? * Yes No
Have you ever been convicted of any offense involving moral turpitude? * Yes No
(Offenses involving "moral turpitude" are those with elements of dishonesty, fraud, deceit, misrepresentation, deliberate violence, or contrary to good morals.)
Have you ever recieved probation, defered adjudication, pled No Contest or Nolo Contendre, pled guilty, or served time in jail/prison? * Yes No
If you answered yes to any of these questions, please explain: (A yes response to any of the above does not automatically eliminate you from employment consideration.)
I hereby affirm that I now live or have previously lived in the following cities and states:

I hereby declare that this information is complete and true to the best of my knowledge and belief. I understand that any misrepresentation or falsification of facts shall be sufficient for disqualification of this application or termination of employment. Furthermore, I understand that the application and records become the property of the district, which reserves the right to accept or reject it. If employed, I further agree to observe all rules, regulations, and policies of the district.

  Please indicate your acceptance by selecting "I agree". *


I understand that in accordance with state law, school districts may obtain a criminal record of all applicants for employment and that the Texas Department for Public Safety and/or other law enforcement agencies may be contacted to provide records.
   
Date: (to be dated in person) Legal Signature of Applicant: (to be signed in person)

VII. ADDENDUM INFORMATION

The Galena Park Independent School District is required by law to obtain crimanal history record information on all applicants for empoloyment 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.
Maiden Name:
The current county name or parrish in which you reside: (example: Harris county)
Date of Birth: (MM-DD-YYYY) *
Sex: *
Ethnicity: *
Driver's License #: *
(Required for US Residents)
Driver's License State:
 
City/Town
County
State
From:
(MM-YY)
To:
(MM-YY)
Last address:
2nd Last address:
3rd Last address:

Please tell us where you heard about Galena Park ISD?