Medina ISD Employment Application for Professional Personnel
PERSONAL DATA
Reaquired field: Last Name
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Reaquired field: First Name
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Middle Name
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Physical Address
Address
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City
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State / Province / Region
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Mailing Address (if different than above)
Address
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City
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State / Province / Region
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POSITION DATA Schools Attended: List all applicable
Reaquired field: Position for which you are applying:
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If yes, give dates of employment:
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EDUCATION/TRAINING Schools Attended: List all applicable information.
Name of School
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City/State
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Course of Study Major/Minor Fields
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Diploma, Degree or Certificate
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Year Graduated (College Only)
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Name of School
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City/State
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Course of Study Major/Minor Fields
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Diploma, Degree or Certificate
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Year Graduated (College Only)
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Name of School
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City/State
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Course of Study Major/Minor Fields
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Diploma, Degree or Certificate
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Year Graduated (College Only)
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CERTIFICATION
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TEACHING EXPERIENCE List teaching experience beginning with most recent years.
Name of School
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City/State
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Type of Assignment
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Dates Taught
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Reason for Leaving
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Name of School
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City/State
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Type of Assignment
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Dates Taught
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Reason for Leaving
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Name of School
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City/State
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Type of Assignment
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Dates Taught
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Reason for Leaving
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Name of School
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City/State
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Type of Assignment
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Dates Taught
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Reason for Leaving
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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
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Position/Title
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Dates Employed
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Reason for Leaving
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School District/Firm Name
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Position/Title
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Dates Employed
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Reason for Leaving
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School District/Firm Name
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Position/Title
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Dates Employed
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Reason for Leaving
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PROFESSIONAL DATA Omit references to organizations that would reveal race, age, ethnic origin, or religious persuasion.
Publications/articles
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Seminars/workshops conducted
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Other related professional activities
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GENERAL INFORMATION
If yes, please give the name of relative and relationship:
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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
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School District/Firm Name
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Mailing Address
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Position/Title
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Full Name of Reference 2
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School District/Firm Name
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Mailing Address
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Position/Title
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Full Name of Reference 3
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School District/Firm Name
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Mailing Address
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Position/Title
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Full Name of Reference 4
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School District/Firm Name
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Mailing Address
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Position/Title
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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.
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Required Fields 
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