APPLICATION FOR PROFESSIONAL EMPLOYMENT

Galena Park Independent School District
Human Resource Services
c/o Online Applicants
14705 Woodforest Blvd.
Houston, Texas 77015
(832) 386-1002
I. PERSONAL INFORMATION
Date of application: 05/09/2008 Date available for employment:   (MM/DD/YYYY)
Last Name: First Name: Middle Name: Soc. Sec. No.
Street Address: City: State: Zip Code:
Home Telephone Number: Business phone:
Email address (please verify, we will be sending email using this address):
Please list a contact person in the event that we are unable to reach you at the above address:
Contact's Name: Phone:
II. POSITION INFORMATION
Check all positions for which you are applying: (please check at least one field)
PK/Kindergarten Special Education Librarian
Elementary, Grades 1-2 Career and Technology Education Counselor
Elementary, Grades 3-5 Physical Education Diagnostician
Middle School, Grades 6-8 Bilingual Education Associate Psychologist
High School ESL Speech Pathologist
    Music Administration
. . Art Other
ELEMENTARY EDUCATION MAJORS ONLY: Check the box next to any subject area below in which you have 18 or more semester hours as shown on your transcripts
SOCIAL STUDIES READING LANGUAGE ARTS SCIENCE MATH OTHER
Are you willing to coach/supervise? Middle School High School    
Football Softball Basketball Swimming Academic Decathlon Debate
Track Volleyball Baseball Soccer Cheerleading Other
III. EDUCATION BACKGROUND (high school through college)
HIGH SCHOOL ATTENDED
LOCATION
NAME USED (If different from current name)
COLLEGE OR UNIVERSITY ATTENDED
DATES OF ATTENDANCE
(MM/YY - MM/YY)
MAJOR
MINOR
TYPE (BS, BA, etc)
YEAR EARNED
NAME USED
(If different from current name)
Name of the college where placement folder is located:

PLACEMENT FOLDERS MUST BE REQUESTED BY THE APPLICANT.
IV. CERTIFICATE AND LICENSE INFORMATION
TYPE OF CERTIFICATE
Elementary, Secondary,
Administrator, Etc.
TEACHING FIELDS
DATE ISSUED
(MM/YY)
EXPIRATION DATE
(MM/YY)
STATE
If you are non-certified, check the avenue through which you are applying for employment: emergency certification (deficiency plan required)
  alternative certification (A.C.P.)
  internship program
For Texas-Certified Applicants:
Has your employment with any Texas school district caused you to be placed on a permit or one-year certificate? Yes No
If a recent college graduate, have you passed all required ExCets? Yes No
V. EXPERIENCE
STUDENT TEACHING EXPERIENCE
Complete this section only if you do not have prior teaching experience.
DATES
(MM/YY)
NAME OF SCHOOL
NAME OF DISTRICT
COOPERATING TEACHER
GRADE/SUBJECT TAUGHT
TEACHING/WORKING EXPERIENCE
List all teaching/working experience beginning with the most recent.
FROM
(MM/YY)
TO
(MM/YY)
NAME OF SCHOOL/ COMPANY
NAME OF SCHOOL DISTRICT
PRINCIPAL/
SUPERVISOR
SUPERVISOR'S
PHONE #
GRADES/SUBJECTS
TAUGHT
List four teaching references. Include administrators and principals under whom you have taught and to whom you are known.
Note: Former and current supervisors may be contacted for reference purposes.
NAME
OFFICIAL POSITION/TITLE
INSTITUTION/SCHOOL DISTRICT
CURRENT PHONE

CONVICTION OF A CRIME, DEFERRED ADJUDICATION, OR IMPOSITION OF PROBATION IS NOT AN AUTOMATIC BAR TO EMPLOYMENT. THE DISTRICT WILL CONSIDER THE NATURE OF THE OFFENSE, THE DATE OF THE OFFENSE, AND THE RELATIONSHIP BETWEEN THE OFFENSE AND THE POSITION FOR WHICH YOU ARE APPLYING.

Have you ever been convicted of a felony or misdemeanor other than a minor traffic violation? Yes No
If yes, state the date and place of arrest, nature of charge, date and courts in which convicted, and subsequent disposition.

Moral turpitude is an act of baseness, vileness, or depravity in the private and social duties which a person owes another member of society or society in general - or which is contrary to the accepted rule of right and duty between persons, including, but not limited to theft, murder, rape, swindling, and indecency.

Has any court ever received a plea of guilty or a plea of "nolo contendere" from you for any offense involving moral turpitude,
deferred further proceedings without entering a finding of guilty, and placed you on probation? Yes No
If yes, please explain:

Why do you desire to leave you present position, or why you left your last position? (Question does not apply to those graduating this year)

Have you ever been involuntarily terminated or asked to resign by another employer or another school district? Yes No
If yes, please give the name of the employer or school district, the date and the reasons for the termination or the request for resignation.

Are you aware of any present circumstances that would prevent you from performing or being eligible for the job for which you are applying,
including but not limited to lack of certification, uncertain immigration status, lack of necessary work experience, etc? Yes No
If so, please elaborate:

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

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.

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)

VI. 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 #:
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?



EQUAL OPPORTUNITY EMPLOYER

It is the policy of the Galena Park Independent School District not to discriminate on the basis of race, color, national origin, sex, handicap, or age in its employment practices as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975, as amended; and Section 504 of the Rehabilitation Act of 1973, as amended.