Medina ISD

Medina ISD Employment Application for Professional Personnel

PERSONAL DATA

Date of Application

Last Name

First Name

Middle Name

Physical Address

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Mailing Address (if different than above)

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Cell Phone No.

Home Phone No.

Email Address:

Name used on records if different from present name

POSITION DATA

Schools Attended: List all applicable

Position for which you are applying:

Credentials included with application:

Resume

All teaching and professional certificates (front and back, if appropriate)

All transcripts showing degrees.

Other

Resume

Upload

Teaching Certification

Upload

Teaching Certification

Upload

Professional Certificate

Upload

Professional Certificate

Upload

Transcript

Upload

Transcript

Upload

Date Available:

Former Medina ISD Employee:

Yes

If yes, give dates of employment:

EDUCATION/TRAINING

Schools Attended: List all applicable information.

Name of School

City/State

Course of Study Major/Minor Fields

Diploma, Degree or Certificate

Year Graduated (College Only)

Name of School

City/State

Course of Study Major/Minor Fields

Diploma, Degree or Certificate

Year Graduated (College Only)

Name of School

City/State

Course of Study Major/Minor Fields

Diploma, Degree or Certificate

Year Graduated (College Only)

CERTIFICATION

Copy

Type of certificate held now

None

Valid Texas

Valid other state

Emergency (Texas)

Texas one-year certificate

Texas temporary administrative

Other

TEACHING EXPERIENCE

List teaching experience beginning with most recent years.

Name of School

City/State

Type of Assignment

Dates Taught

Reason for Leaving

Name of School

City/State

Type of Assignment

Dates Taught

Reason for Leaving

Name of School

City/State

Type of Assignment

Dates Taught

Reason for Leaving

Name of School

City/State

Type of Assignment

Dates Taught

Reason for Leaving

OTHER WORK EXPERIENCE

Please provide a complete listing of all other jobs or administrative positions you have held in the past 10 years. Attach additional sheet if necessary.

School District/Firm Name

Position/Title

Dates Employed

Reason for Leaving

School District/Firm Name

Position/Title

Dates Employed

Reason for Leaving

School District/Firm Name

Position/Title

Dates Employed

Reason for Leaving

Additional sheet

Upload

PROFESSIONAL DATA

Omit references to organizations that would reveal race, age, ethnic origin, or religious persuasion.

Publications/articles

Seminars/workshops conducted

Other related professional activities

GENERAL INFORMATION

Do you have a relative who is a member of the Medina ISD Board of Education?

Reaquired field: Yes

Reaquired field: No

If yes, please give the name of relative and relationship:

Have you even been convicted of a felony or offense involving moral turpitude (including, but not limited to theft, rape, murder, swindling and indecency with a minor)?

Reaquired field: Yes

Reaquired field: No

If yes, please state where, when and the nature of the offense:

Criminal History Record Information Request

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 of Reference 1

School District/Firm Name

Mailing Address

Position/Title

Phone No.

Full Name of Reference 2

School District/Firm Name

Mailing Address

Position/Title

Phone No.

Full Name of Reference 3

School District/Firm Name

Mailing Address

Position/Title

Phone No.

Full Name of Reference 4

School District/Firm Name

Mailing Address

Position/Title

Phone No.

VERIFICATION

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 same to you. I understand that the district is required by Texas Education Code Section 21.917 to obtain criminal history record information on applicants selected for employment. 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 time not to exceed 365 days. Any applicant wishing to be considered for employment beyond this time period may inquire as to whether or not applications are being accepted at that time. If you agree to the statement type your full name and current date below.

Email a copy to

optional

Required Fields

MEDINA ISD

Online Professional Application