PDF Employment Application Miller Grove I.s
PARAPROFESSIONAL EMPLOYMENT APPLICATION
MILLER GROVE I.S.D
APPLICANT INFORMATION
Full Name: __________________________________________________
Last
First
M.I.
Date: _______________________
Address: ___________________________________________ Phone: ________________________________
___________________________________________ Email: _________________________________
Driver's License #: _____________________ Social Sec. No.: _____ - _____ - _____ D.O.B.: ___/___/_____
Date Available: ____________________
Desired Salary: $______________
Position Applying For: Teacher'Aide
Substitute Teacher
Secretary
Are you presently employed? Yes
No If yes, where? ___________________________________________
Have you ever been convicted of a misdemeanor other than a traffic violation? Yes No
If yes, please explain: ________________________________________________________________________
__________________________________________________________________________________________
Have you ever been convicted of a felony? Yes No
If yes, please explain: ________________________________________________________________________
__________________________________________________________________________________________
EDUCATION
High School: ___________________________________
Address: _____________________________________
From: ________ To ________ Did you graduate? Yes No Did you receive a diploma? Yes No
College: ________________________________________ Address: ____________________________________
From: ________ To ________ Did you graduate? Yes No Degree: ___________________________
Other: __________________________________________ Address: ____________________________________
From: ________ To ________ Did you graduate? Yes No Degree: ___________________________
REFERENCES
Please list three professional references.
Full Name: ___________________________________________________________ Relationship: _______________
Company: ____________________________________________________________ Phone: ____________________
Address: _________________________________________________________________________________________
Full Name: ___________________________________________________________ Relationship: _______________ Company: ____________________________________________________________ Phone: ____________________ Address: _________________________________________________________________________________________
Please fill out reverse side
Full Name: ___________________________________________________________ Relationship: _______________ Company: ____________________________________________________________ Phone: ____________________ Address: _________________________________________________________________________________________
PREVIOUS EMPLOYMENT Company: ______________________________________________________ Phone: ________________________ Address: _______________________________________________________ Supervisor: _____________________ Job Title: _________________________ Starting Salary: $______________ Ending Salary: $_________________ Responsibilities: __________________________________________________________________________________ From: __________ To: __________ Reason for Leaving: ______________________________________________ May we contact your previous employer for a reference? Yes No
Company: ______________________________________________________ Phone: ________________________
Address: _______________________________________________________ Supervisor: _____________________
Job Title: _________________________ Starting Salary: $______________ Ending Salary: $_________________
Responsibilities: __________________________________________________________________________________
From: __________ To: __________ Reason for Leaving: ______________________________________________
May we contact your previous employer for a reference? Yes No
CERTIFICATION
Do you possess a valid Texas Teaching Certificate: Yes No
Do you possess a valid Teaching Certificate from another state? Yes No If yes, what state? ________________
If you possess a valid teaching certificate from Texas or any other state or have completed the requirements and are in the process of applying for a certificate, please provide the following information:
Type of Certificate (ex. Provisional)
Level of Certification
Area of Specialization
Effective Date Expiration Date
List any professional organizations to which you belong: ___________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Describe any honors you have received or articles you have published: _______________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ List any other important information you believe important concerning yourself and your potential employment with Miller Grove Independent School District: ______________________________________________________________ _________________________________________________________________________________________________
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. This application will not be considered complete without a college transcript showing the completion of a college degree. You may include any other information that you believe is pertinent with this application.
_________________________________________________ ____________________________
Signature
Date
For Office Use Only: Date Received: ______________________ Date of Interview: ___________________ Interviewed by: _____________________
Comments: ____________________________________________ _____________________________________________ _____________________________________________
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