Medina ISD

Employment Application for Service and Support Person

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

POSITION DATA

Position for which you are applying:

Comments:

Type of Employment:

Full-Time

Part-Time

Summer Only

Date Available:

Former Medina ISD Employee:

Yes

If yes, give dates of employment:

EDUCATION/TRAINING

Mark highest level attained:

Not high school graduate

High school graduate

GED

Less than two years college

Two or more years college

Bachelor’s degree

Master’s degree

Other

Licenses/certifications held

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)

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.

Employer

City/State

Position/Title

Dates Employed

Reason for Leaving

Employer

City/State

Position/Title

Dates Employed

Reason for Leaving

Employer

City/State

Position/Title

Dates Employed

Reason for Leaving

Additional sheet

Upload

SPECIAL SKILLS

List specific skills and/or any machines or equipment you can operate. Include typing speed and number of years experience.

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.

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Required Fields

MEDINA ISD

Online Employment Application for Service and Support Personnel